内镜下密集套扎术治疗食管静脉曲张出血远期疗效的研究

Long-term effect of endoscopic dense ligation on bleeding esophageal varices

目的观察密集套扎法对食管静脉曲张破裂出血的近远期疗效,并对其作出评价。方法将445例肝硬化急性上消化道大出血的患者随机分成两组,治疗组采用食管静脉曲张套扎术(EVL)联合静脉应用奥曲肽、奥美拉唑治疗;对照组静脉应用奥曲肽、奥美拉唑治疗。观察两组术后不同时段内再出血发生率和根治率情况。治疗组267例患者完成全部套扎治疗,共完成482次、3066点套扎,平均每例套扎1.8次,进行回顾性对比。结果 186例急诊出血患者全部套扎止血成功,成功率100%,套扎3个月胃镜复查结果 :267例食管静脉曲张患者中229例根治,根治率为85.7%,而静脉曲张消失率、术后再出血率差异有显著性(P<0.05);并发症两组差异无显著性(P>0.05),治疗组在术后15d,1、3及6个月和3年内再出血发生率明显低于对照组(均P<0.05)。结论食管静脉曲张套扎术(EVL)联合静脉应用奥曲肽、奥美拉唑能有效降低食管静脉曲张破裂出血(EVB)再出血率,减少食管静脉曲张,值得临床推广。

[Objective]To evaluate the short and long-term efficacy of esophageal variceal ligation （EVL） for esophageal variceal bleeding （EVB）. [Methods]445 patients with acute upper digestive tract bleeding enrolled in this study were randomly divided into two groups, the therapeutic group received EVL in combination with intravenous Octreotide and Omeprazole; and the control group was given intravenous Octreotide and Omeprazole. Multiple rubber band ligator was used to ligatebleeding EV in 267 patients, finished 482 times, 3066 points, all patients got one to two times of ligation therapy. The re-bleeding rate and incidence of portal hypertension stomach diseases at different time points were recorded for both groups. [Results]In dense ligation group, the rate of prompt hemostasis of 186 patients was 100%, the rates of complete elimination of EV attained 85.7%. On day 15, and 1, 3, 6 months, and 3 year after operation, the therapeutic group in re-bleeding rate was significantly lower than that in the control group （P〈0.05）, esophageal varices were relieved and portal hypertension stomach diseases did not worsen. [Conclusions]Esophageal variceal ligation in combination with Octreotide and Omeprazole can effectively decrease re-bleeding rate in EVB, ameliorate esophageal varices, and should be clinically recommended.