内镜序贯治疗肝硬化食管胃底静脉曲张的疗效分析

Curative effect after endoscopic sequential therapy for esophageal gastric varices of cirrhosis

目的评价内镜序贯治疗肝硬化食管胃底静脉曲张的临床效果。方法回顾性分析经内镜序贯治疗的193例肝硬化食管胃底静脉曲张患者,采取规范的一级、二级预防,依据静脉曲张分型、分级采用不同内镜治疗方法,按时间节点定期随访序贯治疗,总结评估内镜治疗时机、方法合理性及短期、长期疗效。结果 193例患者胃镜下见食管静脉曲张186例,合并胃底静脉曲张103例,近贲门部胃底静脉曲张4例,IGV1型3例。行食管静脉曲张套扎(EVL)178例,贲门部套扎5例,胃底密集套扎(DEVL)9例,胃底组织胶注射96例,食管套扎点平均7.12环;胃底套扎7～14环,组织胶注射1.0～5.0 ml;平均治疗食管2.68次、胃底1.07次。第1次内镜治疗后静脉曲张消除51例(26.42%)、缓解140例(72.54%)、无效2例(1.04%),治疗有效率为98.96%;1个月后再行治疗,静脉曲张消除113例(58.55%),缓解28例(14.51%),无效1例(0.52%);3个月后再次内镜治疗,静脉曲张完全消除23例(11.92%),缓解6例(3.11%)。近期再出血8例,其中1例死亡。静脉曲张近期治疗总有效率96.89%,远期总有效率99.48%。结论肝硬化食管胃底静脉曲张内镜序贯治疗效果明显,减少出血和再出血风险,提高患者生活质量。

Objective To observe the curative effect after endoscopic sequential therapy for esophageal gastric varices of cirrhosis.Methods 193 patients of cirrhosis were accepted endoscopic sequential therapy treatment for esophageal gastric varices,and accepted the primary and secondary prevention of the specification.Different endoscopic treatment methods were used according to varicse classification and received regular treatment.Results 186 cases were seen esophageal varices under gastroscope in 193 patients.103 cases were combined with gastric varices.4 cases were adjacent the cardia.3 cases were IGV1.178 cases were accepted endoscopic variceal ligation of esophageal.5 cases were accepted endoscopic variceal ligation of the cardia.9 cases were accpeted dense endoscpic variceal ligation of gastric fundus.96 cases were accpeted tissue adhesive sembolization.The average size of the esophagus variceal ligation was 7.12 and the gastric was 7~14.Tissue adhesive was injected 1.0~5.0 ml.The average numbers of treatments were 2.68 times for esophageal varices and 1.07 times for gastric varices.Varices were eliminated in 51 cases after the first endoscopic treatment,and released in 140 cases,invalided in 2 cases.Varices were eliminated in 113 cases by the second endoscopic treatment after 1 month and eased in 28 cases,invalided in 1 case.Varices were eliminated in 23 cases by the third endoscopic treatment after 3 months,and eased in 6 cases.The total effective rate of varicose treatment was 96.89%for recently,and it was 99.48%for the long-term.There were 8 cases hemorrhage recently besides 1 case was death.Conclusions The effect of endoscopic sequential therapy for esophageal gastric varices of cirrhotic is obvious.It reducing the risk of bleeding and rebleeding,can improve the quality of life.