经内镜结扎和硬化剂治疗食管静脉曲张和门脉高压性胃病的疗效及预后

Variceal Ligation Compared with Endoscopic Sclerotherapy for Esophagus Variceal and Portal Hypertensive Gastropathy

目的:观察经内镜结扎和硬化剂治疗食管静脉曲张的疗效及对门脉高压性胃病(PHG)的影响.方法:对92例患者随机分为套扎组(n=43)和硬化剂组(n=49),分别在治疗后1～3月和1～3年内复查.观察静脉曲张及PHG的转归情况.结果:1～3月内复查套扎组完成26例,其中食管静脉曲张根除12例,曲张减轻12例,无效2例,PHG加重17例.硬化剂组完成29例,其中静脉曲张根除4例,曲张减轻22例,无效3例,PHG加重11例.1～3年内复查套扎组和硬化剂组的再曲张率及再出血率分别为61.5%、46.7%和44.4%、33.3%.结论:近期套扎治疗在根治静脉曲张方面优于硬化剂注射,但更易诱发和加重PHG.而套扎组和硬化剂组远期均可出现再曲张和再出血.两组比较无差异.

Purpose: To evaluate the safety and efficiency of variceal ligation(EVL) compared with en-doscopic sclerotherapy(EVS). Methods; 92 patients with liver cirrhosis and recent variceal bleeding were randomized to undergo either treatment; EVL(n =43), EVS(n =49). Varices and portal hypertensive gastropathy(PHG) was evaluated endoscopically at 1 - 3 months and 1 - 3 years after treatment. Results: The rate of variceal eradication was higher in patients after EVL than in patients after EVS. However PHG was significantly worse in the patients who had EVL at 1 - 3 months. Variceal recurrence and rebleeding was more frequent in both of them at 1 - 3 years. Conclusion: EVL was superior to EVS in terms of the rate of variceal eradication but worse in the evolution of PHG. Long-term follow-up studies are required to find out whether or not there are deleterious effects of EVL and EVS.