食管胃底静脉曲张镜下治疗后早期再出血临床观察

Clinical observation of early rebleeding after endoscopic variceal ligation and treatment

目的总结食管胃底静脉曲张镜下治疗前出血量、治疗后早期再出血量及再出血后死亡的发生率。方法收集友谊医院近5年来396例次肝硬化食管胃底静脉曲张出血患者的临床资料，分析食管胃底静脉曲张结扎术和（或）内镜下组织胶注射早期再出血的特点、原因及转归。结果镜下治疗术后早期再出血的发病率为6．6％（26／396）。早期再出血后死亡率为7．7％（2／26）。镜下治疗术后早期再出血的出血量为（177．0±88．8）ml，与治疗前食管胃底静脉曲张出血量[（528．0±298．O）m1]比较，差异有统计学意义（P〈0．05）。结论镜下食管胃底静脉曲张结扎术和（或）内镜下组织胶注射治疗食管胃底静脉曲张出血，操作简便、安全，术中风险小，术后出血．量少。

Objective To summarize the early rebleeding volume and and rate after EVLand/or endoscopic tissue adhesive injection death rate after rebleeding with the treatment of endoscopic variceal ligation （EVL） and/or endoscopic tissue adhesive injection in patients with esophageal and gastric vari- ees. Methods The clinical records were summarized fromfor 396the cirrhosis patients who had suffered cirrhosis with and who had accepted the treatment of EVL and/or endoscopic tissue adhesive injection in in the endoscopic center of Beijing Friendship hospital between Jan. 2005 and Sept. 2011the endoscopy center in Beijing Friendship hospital, and the characteristics, causes and outcomes of early rebleeding To- tally 396 procedures of EVL and endoscopic tissue adhesive injection had been performed in the period between 2005.1 -2011.9 through which the characteristics, sources and outcomes of early rebleeding after EVL and endoscopic tissue adhesive injection were analyzed. Results The incidence of early rebleeding after the treatment of EVL and endoscopic tissue adhesive injection was 6.6% （26/396）. The death rate caused by rebleeding varices was 7.7% （2/26）. Compared with preoperative varices bleeding amount [ （528.0 ± 298.0 ） ml ], the rebleeding volume （ 177.0±88.8） ml after the treatment of EVL and endo- scopic tissue adhesive injection was small, and especially for Child C cases, the difference was significant （P = 0.034）. Conclusion For patients with esophageal and gastric variceal bleeding, the treatment of EVL and endoscopic tissue adhesive injection is easily to apply, it is safety and has lower risk and bleed- ing amount during and after the operation.