内镜下治疗食管静脉曲张出血及预防复发的临床研究

Clinical study of endoscopic treatment of esophageal variceal bleeding and prevention of its recurrence

前瞻性研究内镜下重复注射硬化剂疗法 (EIS)及联合应用内镜下套扎术 (EVL +EIS)两种治疗方法的安全性、疗效、并发症和复发率。方法 51例肝硬化患者符合研究对象 ,随机分为两组 :A组 (EIS组 ) 2 5例 ,B组 (EVL+EIS组 ) 2 6例 ,前组每周重复使用 1%乙氧硬化醇行EIS治疗 ,直至所有曲张静脉均消失 ,后组第一次行EVL ,1周后每周行EIS治疗。结果 EIS及EVL +EIS两组中 ,食管曲张静脉消失率分别为 84 %和 76.9% ,治疗次数分别为 ( 4.2±1.6)次和 ( 3 .0± 0 .4 )次 ,住院时间分别为 ( 4.6± 1.4 )周和 ( 4.5± 1.1)周 ,都无显著性差异。硬化剂使用总量B组显著低于A组 ,分别为 ( 2 2 .6± 8.2 )ml和 ( 42± 10 .5)ml,(P <0 .0 1)。在治疗期间并发症的发生率B组显著低于A组 (P <0 .0 1)。胃镜随访发现食管下端形成环形溃疡和继发性瘢痕 ,其发生率B组较A组为低 ,分别为 2 0 %和 90 .5% ,差异有显著性 (P <0 .0 1)。在平均 12 .5个月的随访中 ,食管静脉曲张复发率B组显著高于A组 ,分别为 4 0 %和 9.5% ,(P <0 .0 5)。结论 EVL +EIS组并发症较少 ,而EIS组在预防静脉曲张复发方面较EVL

Objective The aim of this prospective randomized study is to investigate the safety, efficacy, complications and recurrence of varices after repeated endoscopic injection sclerotherapy (EIS), combined endoscopic variceal ligation (EVL) weekly.Methods Fifty one consecutively treated cirrhotic patients were allocated in two groups, 25 in EIS group and 26 in EVL+EIS gruop. In the former, EIS was given at weekly intervals using 1% aethoxysklerol until all varices disappeared, in the latter EVL was performed initially one week after EVL. EIS was repeated at weekly intervals. Results There was no significant difference between the two with regard to the rate of disappearance of varices (84% vs 76%), the number of treatments (4.2±1.6 vs 3.0±0.4) and duration of hospitalization (4.2±1.4 vs 4.5±1.1 weeks). The total volume of aethoxysklerol used for the EVL+EIS group was significantly less than that for the EIS group (22.6±8.2 vs 42±10.5 ml, P <0.01) and the frequency of minor complications at the initial treatment in EVL+EIS group was significantly ( P <0.01) lower than in that in EIS group. Follow up endoscopy showed that the rate of ulceration and scar formation afterwards in the EVL+EIS group were significantly lower than those in the EIS group (20% vs 90.5%, P <0.01) and in contrast, the frequency of variceal recurrence was significantly higher in EVL+EIS group (40% vs 9.5%, P <0.05) over a mean follow up period of 12.5 months.Conclusion The combined therapy of EVL and repeated EIS have fewer complications, but repeated EIS is superior to combined therapy in having less recurrences.