食管静脉曲张消失后的小探头超声内镜导引加固治疗

目的探讨小探头超声内镜引导下行食管静脉曲张套扎(EVL)治疗食管静脉曲张(EV)消失后的黏膜层加固治疗的价值。方法采用日本富士能450型电子胃镜及SP-701型超声小探头引导下对215例经EVL治疗EV消失的患者行加固治疗。215例随机分成:小探头超声引导下加固组(简称超声加固组)126例;普通电子胃镜下直接加固治疗(简称非超声加固)对照组89例,并随访6～72个月,最后1次随访两组均行超声胃镜检查、并详细记录。观察两组消失EV再出现、再出血及食管旁侧枝静脉增粗变化。结果超声加固组经1～3次超声下加固治疗,随访期间有3例(2.6%)EV未完全闭塞,6例(5.2%)食管旁静脉存在,但无1例EV再出现。而非超声加固组有16例(17.1%)消失的EV再出现,5例发生再出血;有18例(20.2%)消失的EV未完全闭塞,有19例(21.2%)食管旁侧枝静脉增粗。两组有统计学差异(P<0.05～0.01)。结论单纯EVL治疗消失的EV复发率高,而小探头超声内镜引导下行黏膜层加固治疗操作方便、定位准确、能提高加固治疗效果、降低消失的EV复发率,优于非超声内镜下加固治疗。

The evaluation on efficacy of mucosal reinforcement therapy under endoscopic ultrasonography with small probe for recurrence of esophageal varices after EVL

Objective To observe the value of mucosal reinforcement treatment under endoscopic ultrasonography with small probe for recurrence of esophageal varices(EV) after EV ligation(EVL). Methods 215 cases who obtained esohageal varices eradication after EVL were randomly divided into 2 groups: ultrasonographic reinforcement group(126 cases), non-ultrasonographic reinforcement group (89 cases); the follow-up ranged 6-72 months. For all the patients, evaluation after treatment under endoscopic ultrasonography(videoscopy,Fjuinon 450;small ultrasound probe, SP701, 15MHz) was performed at the end of follow-up duration.The recurrence rate,rebleeding rate and paraesophageal varices enlargement following EVL were studied.Results In ultrasonographic reinforcement group,after 1-3 times of ultrasonographic reinforcement, while 3 cases(2.6%) with incomplete blood vessel clotting and 6 cases(5.2%) with paraesophageal varices were found, no recurrence occurred. In non-ultrasonographic reinforcement group, there were 14 cases (17.1%) with recurrence, 5cases with rebleeding, 19 cases (21.2%) with paraesophageal vein enlargement. Conclusion There are high recurrence rates for patients subjected to EVL alone.Mucosal reinforcement therapy under endoscopic ultrasonography with small probe has the advantages of convenient operation and accurate location, leading to better results than that with non-ultrasonographic reinforcement therapy.