内镜治疗食管静脉曲张破裂出血(附385例报告)

ENDOSCOPIC THERAPY FOR THE ESOPHAGEAL VARICEAL BLEEDING

目的 :探讨经内镜治疗食管静脉曲张破裂出血的最佳治疗方案。方法 :自 1988年 2月～ 2 0 0 0年 5月收治肝硬化门脉高压食管静脉曲张破裂出血 385例。临床随机分成 3组 :单纯硬化组 (EVS) 10 3例 ,内镜直视下向静脉内和静脉旁注射 1%乙氧硬化醇 ;单纯结扎组 (EVL) 10 5例 ,分单次结扎和五连环连续结扎 ;联合治疗组 (结扎加硬化治疗 ,EVL +EVS) ,经 1～ 2次结扎后 14d作硬化治疗 ,间隔 1～ 3月对静脉曲张未消失者重复硬化治疗。结果 :6个月内无出血者硬化组 6 6 % ,结扎组 83% ,联合治疗组 92 %。 3～ 6个月内随访 ,食管静脉曲张消失率硬化组 86 % ,结扎组 6 8% ,联合治疗组 91%。结论 :联合结扎和硬化不同步治疗食管静脉曲张破裂出血能增加止血效果 ,提高食管静脉曲张消失率 ,减少内镜治疗次数和硬化剂用量 ,为目前内镜治疗食管静脉曲张破裂出血较为安全有效的方法。

Objective:To determine the best endoscopic method for esophageal variceal bleeding.Methods:385 patients with severe esophageal variceal bleeding were randomly assigned to three groups:endoscopic variceal sclerotherapy (EVS) (n=103),endoscopic variceal ligation (EVL) (n=105) and EVL+EVS(n=177).Results:The percentage of no recurrent bleeding in 6 monthes was 66%(EVS),83%(EVL) and 92%(EVL+EVS).After 3 to 6 monthes' follow-up,the rate of variceal disappearence was 86%(EVS),68(EVL)and 91%(EVL+EVS).Conclusions:Endoscopic therapy combined with successful ligation and sclerotherapy the for severe esophageal variceal bleeding can improve therapeutic effect,raise disappearence rate of esophageal varices and reduce sclerosant dosage.It's a safe and effective method for esophageal variceal bleeding at present.