EVL和EIS序贯治疗食管静脉曲张破裂出血对比研究

Comparative study between EVL and EVL combined with EIS sequential therapy in the treatment of esophageal variceal hemorrhage

目的对肝硬化食管静脉曲张破裂出血患者(EVB)进行内镜下套扎术(EVL)和内镜下套扎术(EVL)+注射硬化剂治疗(EIS)治疗的效果进行对比性研究。方法汇总2008年1月至2018年1月期间我院消化内镜中心82例肝硬化EVB患者临床资料,根据治疗方法不同分为A组(EVL组,42例),B组(EVL+聚桂醇EIS治疗组,40例)。评价两组治疗效果,记录两组的EVL情况和并发症发生情况,两组患者均连续随访1年,记录总有效率及再出血率等指标。结果一:EVL+EIS治疗组的总有效率为95.0%,明显高于单纯EVL治疗组的总有效率59.5%,差异有统计学意义(χ^(2)=10.82,P=0.012);二:EVL+EIS治疗组的平均EVL次数为2.5次,显著少于单纯EVL组的6.5次(χ^(2)=12.78,P=0.0085);三:两组患者治疗期间及治疗后随访1年的并发症发生率无明显差异(P>0.05);四:两组患者术后2周的再出血率分别为8.51%和4.98%,经比较差异无统计学意义(χ^(2)=0.947,P=0.25)。而术后1月、3月、6月、9月、12月的连续随访,单纯EVL组患者的再出血率42.85%明显高于EVL+EIS治疗组10.0%,经比较差异有统计学意义(χ^(2)=14.66,P=0.004)。结论EVL+EIS模式治疗肝硬化EVB相比较于单纯EVL治疗,其治疗总有效率更高,再出血率和平均EVL次数均低于单纯EVL治疗,而且并发症发生率无增加,值得临床工作中推广。

Objective To compare the efficacy of endoscopic variceal ligation(EVL)and EVL+endoscopic injection sclerotherapy(EIS)in the treatment for esophageal variceal bleeding(EVB)in patients with liver cirrhosis.Methods The clinical date of 82 cirrhotic patients with EVB admitted to our hospital from January 2010 to January 2018 were collected.They were divided into group A(EVL group,42 cases)and group B(EVL+EIS group,40 cases)according to the therapeutic methods.The treatment effect of the two groups were evaluated.The frequency of EVL and complications of the 2 groups were recorded.Patients were followed up for 1 year.The total effective rate,rebleeding rate and other indicators were recorded.Results 1.The total effective rate of group B was 95.0﹪,which was significantly higher than that of group A(59.5﹪)(χ^(2)=10.82,P=0.012);2.The average frequency of EVL in group B was significantly fewer than that in group A(2.5 vs 6.5,χ^(2)=12.78,P=0.0085);3.There was no significant difference of complications rates during treatment and 1-year followup between the 2 groups(P>0.05);4.The rebleeding rates at 2 weeks after operation of group A and B were 8.51%and 4.98%,respectively,and there was no significant difference(χ^(2)=0.947,P=0.25).However,with continuous follow-up at 1 month,3 months,6 months,9 months,and 12 months after operation,the rebleeding rate in group A was 42.5%,which was significantly higher than that in group B.The difference was statistically significant(χ^(2)=14.66,P=0.004).Conclusion Compared with EVL alone,EVL+EIS has a higher total treatment effect,a lower rebleeding rate,a fewer average frequency of EVL treatments,and the incidence of complication is not increased.It is worth clinical promotion.