内镜下3种方法治疗食管静脉曲张破裂出血临床效果比较

Comparison of Clinical Effects of Three Endoscopic methods for Esophageal Varices Bleeding

目的:探讨治疗肝硬化导致的食管静脉曲张破裂出血的有效方法。方法:回顾性分析40例因肝硬化致食管静脉曲张破裂出血患者的临床资料,比较采用内镜下套扎、硬化及套扎序贯硬化3种治疗方法的止血率、静脉曲张消失率和再出血率。结果:EVL组、EVS组和EVL+EVS组治疗1个周期后止血率分别为86.67%、92.31%和91.67%,差异无统计学意义(X2=0.299,P=0.861);治疗3周期后静脉曲张消失率分别为80.00%、84.61%和91.67%,差异无统计学意义(X2=0.714,P=0.700)。治疗后3个月、6个月、12个月、24个月再出血率EVL+EVS组<EVS组<EVL组,差异有统计学意义(X2=13.198,P=0.040)。结论:3种方法治疗食管静脉曲张破裂出血均有很好的效果,可根据患者实际情况选择。无特殊适应症的情况下,优先选择EVS或EVL和EVS相配合的序贯疗法可取得较好的效果。

Objective： To implore an effectivemethod for the treatment of esophageal variceal bleeding caused by cirrhosis. Meth- ods： A retrospective analysis of clinical data of 40 patientswith esophageal variceal bleeding caused by cirrhosis was made. the hemostas- is, varicose veins disappearance rate and re-bleeding rate of ligation, sclerotherapy and sequential therapy was compared. Results： The hemostasis rates of EVL group, EVS group and EVL ＋ EVS group were 86.67%, 92.31% and 91.67% after a therapy cycle, of which the difference was not statistically significant （X^2=0.299, P=0.861）. The intravenous varicose disappearance rates were 80.00%, 84.61% and 91.67% after 3-cycle treatment,and the difference was not statistically significant （X^2=0.714,P=0.700）. The order of re-bleeding rates of 3 groups after treatment 3 months, 6 months, 12 months, 24 months was EVL ＋ EVS group 〈EVS group 〈EVL group, and the difference was statistically significant （X^2=13.198, P=0.040）. Conclusion： The three methods for treatment of esophageal varices have very good results, so we could select according to the actual situation of the patients. In the situation of no special indications, preferred EVS or EVL and EVS cooperating sequential therapy can be priority selected and have desirable good results.