食管静脉曲张密集结扎术和硬化及结扎联合术的疗效对照观察

A COMPARISON OF THE OUTCOME OF DENSE ENDOSCOPIC VARICEAL LIGATION AND COMBINATION OF ENDOSCOPIC SCLEROTHERAPY WITH LIGATION IN TREATING ESOPHAGEAL VARICES

比较内镜下食管静脉曲张密集结扎术和内镜下硬化及结扎联合术治疗食管静脉曲张破裂出血的疗效。４２例食管静脉曲张破裂出血病情稳定的病人分为两组，２２例患者接受ＤＥＶＬ，２０例病人行ＥＳ＋ＥＶＬ，两组具有可比性（Ｐ＞０．０５）。第１次治疗，ＤＥＶＬ组每个病人平均结扎１１．３２个点，每根曲张静脉平均结扎２．８３个点；ＥＳ＋ＥＶＬ组首先静脉内注射硬化剂，然后行结扎，第１次治疗平均每根曲张静脉注射硬化剂１．０３次（点），结扎１．０１个点。结果：第１次治疗后，ＤＥＶＬ组食管静脉曲张消失率为５０％，ＥＳ＋ＥＶＬ组为３５％，两组比较无统计学意义（Ｐ＞０．０５）；第１、４、１２及２４周的再出血率，ＤＥＶＬ组为４．５％、４．５％、４．５％、４．５％，ＥＳ＋ＥＶＬ组为１０％、１５％、１５％、２５％，两组无显著差别（Ｐ＞０．０５）。ＤＥＶＬ和ＥＳ＋ＥＶＬ均为治疗食管静脉曲张破裂出血、根除食管静脉曲张的有效方法，ＤＥＶＬ的操作较容易、并发症较少、再出血率较低，内镜下食管静脉曲张密集结扎术将取代内镜下硬化剂注射疗法，成为治疗食管静脉曲张破裂出血的首选方法。

The aim of this article is to compare the effects of dense endoscopic variceal ligation (DEVL)and combination of endoscopic sclerotherapy with ligation (ES+EVL)in treatment of esophageal varices.After recovering from an acute episode of esophageal variceal bleeding,42 patients were divided into two groups.22 were treated with DEVL,20 underwent ES+EVL.They were comparable with regard to clinical and biochemical features and variceal size.In average,every DEVL case received 11 32 ligatures and every varix 2 83;in ES+EVL group every varix accepted 1 03 sleroinjection followed by 1 01 ligature at first attempt.Results:After first procedure,the rate of variceal eradication did not differ significantly between DEVL and ES+EVL group(50% vs.35%, P >0 05),The rebleeding rates after 1,4,12 and 24 weeks were 4 5%,4 5%,4 5%,4 5% in DEVL and 10%,15%,15%,25% in ES+EVL respectively,with no significant difference( P >0 05) Both DEVL and ES+EVL are effective methods in treating varices,howerer,DEVL is easier to perform than ES+EVL,with less com plications,and lower rebleeding rate.