食管静脉曲张出血硬化治疗十三年回顾

Retrospect of thirteen years' experience in sclerotherapy for esophageal variceal bleeding

目的 评价食管静脉曲张出血硬化治疗疗效。方法 对我院 1987年 4月至 2 0 0 0年 5月行食管静脉曲张硬化治疗 (EVS)的 10 10例门脉高压食管静脉曲张出血患者 ,进行回顾分析。肝硬化患者 85 0例 ,肝癌 16 0例 ,共行EVS 32 0 3例次 ,急诊 6 0 2例次 ,择期 2 6 0 1例次 ,追加治疗 5 0 2例次 ,710例肝硬化患者首次进行EVS(3.18± 1.1)次 ,对 5 79例肝硬化患者进行了 3～ 15 7个月的随访 ,平均随访时间为 (4 2 .47± 32 .78)个月。肝硬化患者 85 0例 ,其中治疗结束时 70 6例行胃镜检查。结果 1.全组急诊止血率为 97.0 % ,治疗并发症为 13.4% ,死亡率为 1.8%。 2 .肝硬化患者食管静脉曲张消失和基本消失率为 84.1% ,远期再发出血率为 2 3.7% ,生存率按Kaplan Meier法计算 ,1、3、5、10年分别为 (95 .8± 0 .8) %、(86 .1± 1.6 ) %、(74.5± 2 .4) %和 (5 3.6± 3.8) %。结论 EVS对食管静脉曲张出血仍是一重要治疗方法。

Objective To evaluate the efficacy of scle rotherapy (EVS) for esophageal variceal bleeding. Methods Retrospective analysis was made in 1 010 patients with es ophageal variceal bleeding who underwent sclerotherapy, among them 850 patie nts were cirrhosis and 160 patients were hepatocellular carcinoma. The total num ber of procedures of sclerotherapy were 3 203, including 602 for emergency scler otherapy and 2 601 for selective sclerotherapy. Supplementary sclerotherapy was performed in 502 cases. Average procedures of sclerotherapy for initial treatme nt were 3.18±1.1 in 710 cirrhotic patients. Follow-up was made in 579 cirrhosi s patients for 3-157 months, with an average follow-up period of (42.47±32.78) months. Results 1. The hemostasis rate in the whole group was 97.0%, the c omplication rate was 13.4%, and the mortality was 1.8%. 2. Rate of complete and nearly complete elimination of esophageal varices in cirrhotic patients was 84 .1 %, and long term rebleeding rate was 23.7%. Survival rates were (95.8±0.8)% 、(86.1±1.6)%、(74.5±2.4)%、(53.6±3.8)% at 1,3,5 and 10 year according to t he Kaplan-Meier analysis. Conclusions EVS is an important method of treatment for esophageal variceal bleeding.