内镜下静脉曲张套扎联合内镜下静脉曲张硬化术治疗食管静脉曲张出血的临床研究

CHnical study on endoscopic variceal Hgation combined with endoscopic variceal sclerosis for treating patients with esophageal variceal bleeding

目的探讨内镜下静脉曲张套扎（EVL）联合内镜下静脉曲张硬化术（EVS）治疗食管静脉曲张出血（EVB）的临床疗效和安全性。方法90例EVB患者根据治疗方法分为EVL联合EVS治疗组（观察组，45例）和EVL治疗组（对照组，45例）。观察两组首次治疗后静脉曲张消除情况、达到静脉曲张消除所需时间、消除所需治疗次数、再出血、静脉曲张复发、并发症及预后等。结果观察组静脉曲张消除率为97．8％（44／45），对照组为93．3％（42／45），两组比较差异无统计学意义（P〉0．05）。观察组首次治疗后静脉曲张消除率明显高于对照组，达到静脉曲张消除所需时间和消除所需治疗次数均显著低于对照组[71．1％（32／45）比48．9％（22／45）、（17．24±5．65）d比（36．01±11．81）d、（1．42±0．47）次比（1．87±0．61）次，P〈0．05或〈0．01]。观察组早发再出血率、迟发再出血率、静脉曲张复发率分别为4．4％（2／45）、6．7％（3／45）、2．2％（1／45），显著低于对照组的17．8％（8／45）、22．2％（10／45）、22．2％（10／45），差异有统计学意义（P〈0．05）。观察组并发症发生率为11．1％（5145），显著低于对照组的42．2％（19／45）（P〈0．01）。结论EVL联合EVS可使EVB患者快速止血，并能预防再出血。

Objective To investigate the clinical efficacy and safety of endoscopic variceal ligation （EVL） combined with endoscopic variceal sclerosis （EVS） for treating patients with esophageal variceal bleeding （EVB）. Methods Ninety patients with EVB were divided into observation group and control group by treatment methods with 45 patients each. The observation group was given EVL combined with EVS and the control group was given EVL. The elimination of varicosity after the first treatment,time and times required to eliminate, rehaemorrhagia, varicosity recurrence, complication and prognosis of the 2 groups were observed. Results The elimination rate of varicosity of observation group was 97.8% （44/45）,the control group was 93.3% （42/45）, there was no significant difference （P 〉 0.05）. The elimination rate of varicosity after the first treatment of observation group was significantly higher than that of control group, the time and times required to eliminate were significantly lower than those of control group [ 71.1% （32/45） vs. 48.9% （22/45）, （17.24 ±5.65） d vs. （36.01 ± 11.81） d, （1.42 ±0.47） times vs. （1.87 ±0.61） times,P 〈 0.05 or 〈0.01 ]. The rates of early-onset rehaemorrhagia,delayed rehaemorrhagia and varicosity recurrence of observation group were significantly lower than those of control group [ 4.4% （2/45） vs. 17.8% （8/45）, 6.7% （3/45） vs. 22.2% （10/45）,2.2% （1/45） vs. 22.2% （10/45）,P 〈0.05]. The rate of complication of observation group was significantly lower than that of control group [ 11.1% （5/45） vs. 42.2% （ 19/45 ）, P 〈 0.01 ]. Conclusion The EVL combined with EVS is an effective method for emergency hemostasis and preventing rehaemorrhagia in the patients with EVB.