食管静脉曲张治疗后复发出血的临床分析

CLINICAL ANALYSIS OF REBLEEDING AFTER SCLEROTHERAPY IN ESOPHAGEAL AND GASTRIC VARICES

探讨食管静脉曲张硬化治疗后复发出血的规律及有关因素。对２６０例肝硬化食管静脉曲张硬化治疗后患者，追随观察６到７２个月，对反复出血的５５例患者进行临床分析。本组复发出血率为２１．２％，一年内复发出血占６９％，５２例再次接受硬化治疗，急诊止血率为９６．１％。追随期中，死亡８例，其中３例死于出血。存活４７例，生存期１～６年。结论：１．复发出血与肝功能、门静脉主干宽度无明显关系，而与静脉曲张消失和基本消失率低以及其他门体静脉侧支未建立有关。２．复发出血者小中量占多数。３；对复发出血的规律及如何预防复发出血作了简要讨论。

The purpose of this study was to observe the regularity and affecting factors of rebleeding in patients with esophageal and gastric varices after sclerotherapy. Fifty five of 260 patients with cirrhosis of post-scleratherapy had been followed up for 6 to 72 months occured rebleeding. The rebleeding rate was 21. 2 % .of 55 patients, 38 cases occurred rebleeding within one year. So the rebleeding rate of one year is 69 % in all of the rebleeding patients. The quantity of rebleeding was less than that of primary bleeding in most patients. fifty two cases accepted the sclerotherapy again. Although 8 patients died , only 3 died of re- bleeding. The other 4 7 patients remained survival. There was no relationship between the rebleeding and the hepatic function and the width of portal vein , but a relationship could be found between the rebleeding and the degree of occlusion of eaophageal varices and whether other major portal-systemic collateral route were established in adition to esophageal varices such as paraumbilical veins. ln conclusion we propose : 1 . The patients who have accepted the treatment of sclerotherapy should be foUowed up by endoscopy for whole life. 2. When rebleedings occur the patients should be treated with sclerotherapy again. 3. lf rebleed- ing are repeated more than three times , patients should select other treatments which can relieve the hyper- tension of portal vein such as drugs ; shunt ; PSE ; TIPS and so on.