内镜套扎联合硬化剂夹心法治疗食管静脉曲张破裂出血的远期疗效观察

Endoscopic variceal ligation joint hardener sandwich method long-term efficacy of the treatment of esophageal varices

[目的]探讨内镜下静脉曲张套扎同时应用硬化剂夹心法(套扎-硬化-套扎即EVL-EVS-EVL)治疗食管静脉曲张破裂出血的疗效。[方法]对23例肝硬化食管静脉曲张破裂出血的患者采用夹心法治疗,每条曲张静脉结扎皮圈不超过3个,并在2个结扎点之间的曲张静脉内注射l^3ml硬化剂。其中10例在首次内镜治疗时接受食管静脉造影检查。于治疗后2周、1个月、3个月、6个月、12个月胃镜随访,了解静脉曲张变化情况,记录患者不良反应及并发症。[结果]10例行静脉造影检查中7例硬化剂在曲张静脉内滞留时间超过40min。夹心法控制活动性食管静脉曲张出血的止血成功率为100%,静脉曲张消除率为86.9%(20/23),再出血发生率为8.6%(2/23),随访期内静脉曲张复发率为13.0%(3/23)。[结论]夹心法能使硬化剂在曲张静脉内滞留较长时间,在一次治疗后能有效提高静脉曲张消除率,降低再出血率及静脉曲张复发率,是内镜下治疗食管静脉曲张破裂出血的较理想选择。

[Objective]to explore the endoscopic variceal ligation efficacy of applicanon sclerotherapy method （ligation- hardening - ligation） treatment of esophageal variees. [Methods] Twenty-three patients with cirrhosis and esophageal varices bleeding in patients with sandwich method （EVL-EVS-EVL） combi- nation therapy,each varicose veins balance Zappi circle of not more than three,and varicose veins between the two ligation points injected 1 to 3 ml of hardening agent. Of which 10 were accepted in the first endo- scopic treatment of esophageal venography. Records of patients with adverse reactions and complications af- ter treatment for two weeks in one, three, six and twelve months endoscopic follow for varicose veins change. [Results]Ten routine venography in seven cases hardener residence time in the varicose vein over 40 minutes. The sandwich method to control the activity of esophageal variceal bleeding （EVB） hemostatic success rate of 100% ,and variceal obliteration rate was 86.9% （20/23） ,rebleeding rate was 8. 6%（2/23）, the follow-up period,the intravenous varicose recurrence rate was 13.0% （3/23）. [Conclusion]The sand- wich method hardener can remain in the varicose vein long time, after the first treatment can effectively im- prove varicose veins removal rate and reduce the rate of rebleeding and variceal recurrence rate. Is the endo- scopic therapy EVB compared ideal choice.