晚期血吸虫病食管静脉曲张套扎术后早期出血的临床分析

Clinical analysis of early esophageal varices bleeding after endoscopic varices ligation in advanced schistosomiasis patients

目的探讨晚期血吸虫病（晚血）食管静脉曲张套扎术（EVL）后早期出血的发病特点。方法回顾性研究本院收治的206例行EVL治疗的晚血患者,统计出现术后早期出血的例次数、好发时间、原因或诱因、基础疾病、预后等。结果共有17例行EVL患者发生早期出血,其中1例死亡,早期出血率为8.25%,死亡率为0.5%。出血均发生于术后第4-12天,其中发生于术后第7-9天的有13例（76%）。导致出血的直接原因为套扎环脱落后创面出血;诱因是饮食不当（10例,58.8%）和腹压增加（6例,35%）,不明原因1例。出血均发生于首次EVL术后肝功能Child-Pugh C级患者。结论EVL术后早期出血发病率和死亡率均较低,好发时间为术后第7-9天,应注意饮食因素和护理,肝功能Child-Pugh C级患者是早期出血的重点高危人群。

Objective To study the clinical characteristics of early esophageal varices bleeding after endoscopic varices ligation（EVL）in advanced schistosomiasis patients. Methods The data of 206 advanced schistosomiasis patients who received VEL were collected and studied retrospectively. Results There were 17 cases of early esophageal varices bleeding after EVL including 1 died case,the early hemorrhage rate was 8.25%,and the mortality rate was 0.5%. The early bleeding occurred from the 4th to 12 th day,and 76% occurred from the 7th to 9th day postoperatively. The direct cause of hemorrhagic was ligation ring falling off,and the inducements were the improper diet（10 cases,58.8%）and increased abdominal pressure（6 cases,35%）.All the cases of early esophageal varices bleeding occurred in the patients whose liver function being Child-Pugh C. Conclusions The incidence and mortality of EVL early postoperative hemorrhage are both low,and mostly occur from the 7th to 9th day postoperatively. We should pay attention to the diet and nursing,and the patients with Child-Pugh C liver function are the high risk group.