内镜下不同方法治疗肝硬化致食管胃底静脉曲张的效果及短期复发率比较

Comparison of Curative Effect and Short-term Recurrence Rate of Different Endoscopic Methods in Treatment of Patients with Esophageal Gastric Fundus Varix Induced by Liver Cirrhosis

目的比较内镜下套扎(EVL)、内镜下硬化剂注射(EVS)和内镜下套扎联合硬化剂注射(ESL)治疗肝硬化食管胃底静脉曲张的临床效果以及短期复发率。方法选取2012年3月—2016年3月确诊为肝硬化食管胃底静脉曲张出血的患者150例为研究对象。依据治疗方法不同分为EVL组、EVS组和ESL组,每组50例。比较3组的临床疗效、短期复发率和再出血率,并记录术后并发症情况。结果 3组的止血成功率、静脉曲张消失率、低热和溃疡出血发生率比较差异无统计学意义(P>0.05)。EVL组和EVS组短期复发率和再出血率明显高于ESL组(P<0.05)。EVS组胸骨后疼痛和吞咽梗阻感发生率显著高于ESL组(P<0.05)。结论 EVL和EVS治疗肝硬化食管胃底静脉曲张临床效果较好,但联合使用可显著降低短期复发率、再出血率以及并发症发生率。

Objective To compare clinical curative effect and short-term recurrence rate among endoscopic variceal ligation （EVL）, endoscopic variceal sclerotherapy （EVS） and EVL combined with endoscopic scleroligation （ESL） in treatment of patients with esophageal gastric fundus varix induced by liver cirrhosis. Methods A total of 150 patients with cirrhosis and esophageal varices bleeding during March 2012 and March 2016 were divided into EVL group, EVS group and ESL group （ n =50 for each group） according to different treatment methods. Clinical efficacy, short-term recurrence rate and rebleeding rate were compared, and incidence rates of postoperative complications were recorded among 3 groups. Results There were no significant differences in successful rate of bleeding, varix disappearance rate and incidence rates of low-grade fever and ulcer bleeding among 3 groups （ P 〉0.05）. The short-term recurrence and rebleeding rates in EVL and EVS groups were significantly higher than those in ESL group （ P 〈0.05）. Incidence rates of retrosternal pain and dysphagia in EVS group were significantly higher than those in ESL group （ P 〈0.05）. Conclusion Both EVL and EVS have good clinical effects in treatment of patients with esophageal gastric fundus varix induced by liver cirrhosis, but combined use may significantly reduce short-term recurrence rate, rebleeding rate and incidence rate of complications.