贲门血管硬化剂注射联合套扎法治疗肝硬化重度食管静脉曲张并贲门静脉曲张的疗效观察

Efficacy of cardiacendoscopic varicealslerotherop plus endoscopic varicealligation in treating severe esophageal varices

目的分析比较贲门血管硬化剂注射联合套扎法和单独套扎法治疗肝硬化重度食管静脉曲张并贲门静脉曲张的疗效。方法回顾性分析三六三医院2012年1月至2015年6月具有重度食管静脉曲张并贲门静脉曲张的29例肝硬化患者,分为套扎法和联合治疗法两组,比较两组近期和远期的治疗效果、再出血率、复发率、生存率以及并发症发生情况。结果联合组临床总有效率为93. 75%,显著高于EVL组的53. 85%(P <0. 05); EVL组手术完成后出现并发症3例,联合组出现2例,两组并发症发生率比较无统计学差异(P> 0. 05)。经定期电话随访400 d,EVL组中再次出现活动性曲张静脉出血或具有出血征发生率为61. 54%,显著高于联合治疗组的12. 50%(P <0. 05); EVL组静脉曲张复发率为53. 85%,显著高于联合组的6. 25%(P <0. 05);联合组的死亡率为0. 00%,明显低于EVL组的38. 46%,联合组生存率显著高于EVL治疗组(P <0. 05);两组随访期间并发症发生率分别46. 15%、31. 25%(P> 0. 05)。结论贲门血管硬化剂注射联合套扎法治疗肝硬化重度食管静脉曲张并贲门静脉曲张的疗效显著,能降低静脉曲张再出血率、病死率及复发率,减少并发症的发生,提高生存率,效果优于单独套扎法。

Objective To compare the efficacy of cardiopulmonary sclerotherapy combined with ligation and ligation in the treatment of severe esophageal varices with variceal varices. Methods A retrospective analysis of 29 patients with cirrhosis with severe esophageal varices and varicose veins from January 2012 to June 2015 was divided into two groups: the ligation method and the combination therapy. Long-term treatment effects, rebleeding rate, recurrence rate, survival rate,and complications. Results The total effective rate was 93. 75% in the combined group, which was significantly higher than 53. 85% in the EVL group (P <0. 05). There were 3 cases of complications in the EVL group and 2 cases in the combined group. There was no complication rate in the two groups. Statistical difference ( P > 0. 05 ). After a regular telephone follow-up of 400 days, the incidence of active variceal hemorrhage or bleeding in the EVL group was 61. 54%, which was significantly higher than that in the combination group ( 12. 50%, P <0. 05). The recurrence rate of varicose veins in the EVL group was 53. 85%, significantly higher than the combined group of 6. 25%(P<0. 05);the combined group mortality was 0. 00%, significantly lower than the EVEL group of 38. 46%, the combined group survival rate was significantly higher than the EVL treatment group ( P < 0. 05 );The incidence of complications during the follow-up period was 46. 15% and 31. 25%, respectively (P >0. 05). Conclusion Cardiac sclerotherapy combined with ligation is effective in the treatment of severe esophageal varices and variceal varices in cirrhosis, which can reduce the rate of re-bleeding, mortality and recurrence of varices, reduce complications and improve survival rate. Better than separate ligation.