内镜下套扎术与普萘洛尔预防肝硬化食管曲张静脉首次出血的对照研究

Comparison of endoscopic band ligation and propranolol for the primary prophylaxis of variceal bleeding in cirrhosis

目的:比较内镜下食管曲张静脉套扎术(endoscopic variceal ligation,EVL)与β受体阻滞剂普萘洛尔对预防首次食管曲张静脉出血的疗效及其安全性。方法:选取食管静脉曲张的肝硬化病人168例,随机分成EVL组和普萘洛尔组,分别单独接受EVL和普萘洛尔治疗,比较其疗效和安全性。结果:两组患者治疗前指标比较无明显差异,术后随访时间18～36个月。EVL组共有24例(28.6%)病人发生出血;普萘洛尔组有20例(23.9%)病人发生出血,两组差异无统计学意义(P>0.05)。总体病死率以及与出血相关的病死率无明显差异(分别21.4%vs 17.9%,7.1%vs 6.0%,均P>0.05),EVL组出现不良事件43例,其中3例危及生命;普萘洛尔组发生不良事件16例,两组差异无统计学意义(51.19%vs 19.05%,P<0.05)。结论:普萘洛尔与EVL对预防首次食管曲张静脉出血的疗效无明显区别,但普萘洛尔引起的并发症要少于EVL。

Objective： To compare endoscopic variceal ligation （EVL） with propranolol for prophylaxis of first variceal bleeding. Methods： We chose 168 patients with cirrhosis and esophageal varices in our hospital and allocated them to EVL and propranolol groups. Treatment effectiveness and safety in the 2 groups were observed. Results： he parameters of two groups were similar before therapy. Follow-up period was 8-36 months. Variceal bleeding occurred in 24 （28.6%） of the EVL group and in 20 （23.9%） of the propranolol group （P〉0.05）. Overall mortality and death related to bleeding were similar （21.4% vs 17.9%; 7.1% vs 6.0%, P〉0.05）. Adverse events related to EVL were 43 （3 of them life-threatening） compared to 16 in the propranolol group （51.19% vs 19.05%, P〈0.05）. Conclusion： Propranolol may be the better choice in prophylaxis of variceal bleeding with similar effects and lower adverse events than with EVL.