食管胃底静脉曲张内镜下根治联合心得安序贯治疗的远期疗效分析

Long- term efficacy of radical treatment under endoscope for esophageal and gastric varices combined with propranolol

目的:评价食管胃底静脉曲张内镜下根治性治疗联合心得安治疗肝硬化食管胃底静脉曲张出血的远期疗效。方法:随访观察2007年7月至2010年7月的乙型肝炎肝硬化食管胃底静脉曲张患者208例,根据患者意愿及之后的随访资料将其分为3组:A组:内镜下根治治疗+心得安序贯治疗组,即根据食管胃底静脉曲张程度行内镜下治疗,直至曲张静脉消失或不能再行内镜下治疗,内镜治疗结束后开始序贯口服心得安行降低门脉压治疗;B组为内镜下根治治疗组,未服用心得安;C组:一次内镜下治疗+心得安序贯治疗组。所有患者均进行内镜随访,随访时间为3年,分别记录静脉曲张消除例数,近期出血、远期出血例数及发生并发症情况。结果:3种治疗方案中近期再出血率比较差异无显著性意义(2.9%、4.5%、3.6%),而根治性治疗的静脉曲张消除率A、B组(89.9%、89.5%)显著高于仅行一次内镜治疗(39.3%)。在远期再出血率方面,内镜下食管胃底曲张根治治疗A、B组(40.6%、53.7%)显著低于一次内镜治疗组(76.8%),而根治治疗联合序贯心得安治疗(89.9%)与仅行根治治疗(89.5%)比较,静脉曲张消除率无显著差异,但A组远期再出血率最低(40.6%、53.7%、76.8%)。结论:内镜下食管胃底静脉曲张根治性治疗联合序贯心得安疗法在对食管胃底静脉曲张的静脉曲张消除率及远期出血率方面都有一定的优势,可供临床参考。

Objective： To evaluate the long-term efficacy of radical treatment under endoscope combined with propranolol for esophageal and gastric variceal bleeding in patients with cirrhosis.Methods： From July 2007 to July 2010, a follow-up study was conducted among 208 B hepatitis patients with cirrhosis and esophageal and gastric varices who were divided into three groups （ group A, group B, group C） according to the willings of their families and the follow-up data.In group A （ radical treatment ＋propranolol, sequentially） , patients were treated under endoscope based on the level of esophageal and gastric varices till vari-cose veins were eliminated or endoscopic treatment was no longer applicable, then they were given propranolol orally to reduce portal vein pressure.In group B （radical treatment）, patients were given only radical treatment without propranolol.In group C, patients were given endoscopic treatment for only one time then propranolol orally.All patients, occurrences among whom in terms of vein elimination, short-term bleeding, long-term bleeding and complications were recorded, were followed up with endo-scope for three years totally.Results： No significant difference in the rate of short-term bleeding was found among the three groups （2.9%, 4.5%, 3.6%）, while the rates of vein elimination in both group A and group B （89.9%, 89.5%） were sig-nificantly higher than group C （39.3%） .As to the rate of long-term bleeding, both group A and group B （40.6%, 53.7%） were significantly lower than group C （76.8%） .When it comes to vein elimination rate, though no significant difference was found between group A （ 89.9%） and group B （ 89.5%） , the lowest rate of long-term bleeding was observed in group A （40.6%, 53.7%, 76.8%） .Conclusion： For clinical reference, radical treatment under endoscope combined with propranol-ol for esophageal varicose has advantages with respect to vein elimination and long-term bleeding of esophageal and gastric vari-ces.