断流术和内镜下治疗食管静脉曲张出血的疗效分析

ANALYSIS OF SURGICAL AND ENDOSCOPIC THERAPEUTIC EFFECT FOR ESOPHAGEAL VARICES BLEEDING

目的 :比较内镜下套扎术 (EVL)结合硬化剂注射 (EVS)和食管胃底静脉断流术对食管静脉曲张出血的近期和远期疗效。方法 :12例肝硬化门脉高压病人行食管胃底静脉断流术 ,其中 6例术后行EVL或EVS ;32例食管静脉曲张行EVL加EVS ;9例食管静脉曲张行EVL ;5例食管静脉曲张行EVS。所有病人术后随访 3～ 5年 ,观察复发和再出血情况。结果 :食管胃底静脉断流术对急性出血的止血效果肯定 ,但术后仍存在程度不同的曲张静脉 ,术后 3～ 5年内再出血发生率高达 6 6 7% (8/ 12 )。术后择期行EVL和EVS ,可以使曲张静脉完全消失 ,达到满意的远期疗效。EVL结合EVS后 ,曲张静脉完全消退 93 75 % (30 / 32 ) ,总疗程 2～ 3wk。内镜下治疗后 ,3～ 5年内曲张静脉复发率为 10 5 3 % (4/ 38) ,再出血发生率 6 5 2 % (3/ 46 )。结论 :EVL联合EVS对食管静脉曲张破裂出血的近期和远期疗效明显优于手术组。食管胃底静脉断流术后施行EVL或 (和 )EVS可以同时达到降低门脉压力和消除曲张静脉的目的 ;

Objective:To compare short and long term results of the combination of endoscopic esophageal variceal sclerotherapy(EVS) and esophageal variceal ligation(EVL),and esophageal-gastric variceal surgery for esophageal varices bleeding.Methods:12 patients with esophageal-gastric disorders were operated, then,six of them were treated by EVL or EVS again after operation because of bleeding.32 patients with esophageal varices were cured by EVS and EVL.9 patients were by EVL,5 patients were by EVS.All patients were followed up 3～5 years period after treatment in order to observe the recurrence and bleeding.Results:Surgery had affirmative effect in the control of active bleeding,but after operation it remained varices in different degree. Rebleeding occurred with 3～5 years in 66.7%.While with elective treatment of EVL and EVS,the varices reduced completely. The combinatin of EVL and EVS made varices in 93.75% and course of treatment 2～3 week.After endoscopic treatment,varices recurrent rates within 3～5 years was 10.53% and rebleeding was 6.52%.Conclusion:The effect of the combination of EVL and EVS for esophageal varices bleeding had an advantage over operation.Combination of surgery and EVL or EVS could reduce portal hypertension and remove residual varices.The effect of combination of EVL and EVS was superior to EVL or EVS alone.