奥曲肽治疗肝硬化食管胃底静脉曲张破裂出血的疗效观察

目的观察国产奥曲肽治疗食管胃底静脉曲张破裂出血的临床效果。方法选择病人120例，随机分为奥曲肽组和垂体后叶素组两组。①奥曲肽组60例，给予国产奥曲肽200μg稀释缓慢注射后，再以50μg／h滴注，每天总量1200μg，有效者再连续用4d．②垂体后叶素组60例，给予垂体后叶素10IU稀释缓慢注射后，再以0．2IU／min滴注，每天总量288IU，有效者再连续用4d。结果两组治疗前的基本资料相似，有可比性。奥曲肽组的止血率在用药后12h、24h、48h、72h分别为71．6％、88．3％、91，6％、95．0％，均明显高于垂体后叶素组的51.7％、66．6％、70.0％、75.0％。国产奥曲肽组总有效率95．0％，亦明显高于垂体后叶素组的75．0％。国产奥曲肽再出血率为11．7％，明显低于垂体后叶素组再出血率23．3％。国产奥曲肽组未见明显不良反应。结论国产奥曲肽（50μg／h）治疗食管胃底静脉曲张破裂出血有显著的疗效，使用安全方便，缩短了止血时间，提高了止血成功率，再出血率低，未见明显的不良反应。     

国产醋酸奥曲肽治疗食管胃底静脉曲张破裂出血的疗效观察

目的评价国产醋酸奥曲肽治疗肝硬化食管胃底静脉曲张破裂出血的临床疗效。方法64例食管胃底静脉曲张破裂出血患者随机分成两组，治疗组首次静脉推注国产醋酸奥曲肽0．1mg，继以0．05mg／h连续静脉滴注72-96h；对照组给予垂体后叶索0．2-0．4u／min持续静脉滴注72-96h，高龄或伴有冠心病患者联合应用硝酸甘油0．8mg／h，观察2组的止血率及不良反应。结果治疗组止血率为93．8％，不良反应率为9．7％，对照组止血率为53．6％，不良反应率为42．2％，两组止血率及不良反应率差异有统计学意义（P〈0．01）。结论国产醋酸奥曲肽治疗食管胃底静脉曲张破裂出血的疗效明显高于垂体后叶素，且不良反应少，有很高的临床价值。     

食管胃静脉曲张出血急诊内镜治疗后奥曲肽疗程对患者预后的影响

目的 探讨食管胃静脉曲张出血的患者急诊内镜止血后,奥曲肽使用疗程对预后的影响.方法 纳入首次食管胃静脉曲张出血行急诊胃镜治疗的患者,分为奥曲肽2d治疗组和奥曲肽5 d治疗组,评估两组患者疗效、早期再出血及死亡情况.结果 纳入符合标准的食管胃静脉曲张破裂出血患者86例.奥曲肽2 d治疗组和5 d治疗组中分别有2例(4.7...     

急诊内镜下套扎治疗食管静脉曲张破裂出血

目的 总结急诊内镜下紧急套扎治疗食管静脉曲张破裂出血的经验。方法 对84例食管静脉曲张破裂出血病人在急诊情况下紧急内镜下套扎，观察止血效果。结果 急诊止血成功率98.8％，术中无并发症发生，近期再出血率4.76％。结论 急诊EVI，治疗食管静脉曲张破裂出血是一种安全、有效、快捷的止血方法。     

联合应用特利加压素和内镜套扎治疗食管静脉曲张破裂出血

目的:观察评价特利加压素、内镜套扎和联合上述两种方法治疗食管静脉曲张破裂出血的疗效.方法:56例患者分为三组,其中特利加压素组19例,内镜套扎组20例,联合治疗组17例.结果:72小时止血率在三组分别为68.4%,80%和94.l%;一周内再出血率为30.8%,12.5%和6.3%;急诊手术率为26.3%,21.1% 和5.9%.联合治疗组的72小时止血率明显高于其他两组(P<0.05),一周再出血率和急诊手术率低于其他两组(P<0.05) .特利加压素组和内镜套扎组的72小时止血率则没有差别(P>0.05 ).结论:食管静脉曲张破裂出血时联合应用特利加压素和内镜套扎治疗可以提高止血率、降低近期再出血率和急诊外科手术率.     

奥曲肽联合奥美拉唑治疗食管胃底静脉曲张破裂出血疗效观察

将59例肝硬化食管胃底静脉曲张破裂出血（EGVB）患者随机分为观察组和对照组,两组均常规禁食,补充维生素K1和血容量等,并予以输血。观察组予奥曲肽联合奥美拉唑静滴,对照组予奥美拉唑联合垂体后叶素静滴。结果与对照组比较,观察组平均止血时间缩短、输血量减少,止血率明显提高,不良反应减少,再出血率明显降低,P均〈0.05。认为奥曲肽联合奥美拉唑治疗EGVB安全有效、副作用少,尤其适用于老年患者。     

奥曲肽治疗食管静脉曲张破裂出血的疗效观察

为了观察奥曲肽对食管静脉曲张破裂出血的疗效,80例患者随机分为3组:25例用奥曲肽(治疗组),26例用脑垂体后叶素加凝血酶(对照组A),29例用三腔二囊管压迫(对照组B),将止血率、止血速率、平均输血量及再出血率进行对比.结果显示奥曲肽取得较好疗效(P<0.001),副作用少,仅有3例恶心,并为内镜治疗及外科治疗创造手术条件.     

奥曲肽治疗肝硬化食管静脉破裂出血29例疗效观察

目的观察奥曲肽对食管静脉破裂出血的治疗效果。方法29例食管静脉破裂出血住院病例（均为胃镜证实）随机分成两组：治疗组（14例）采用奥曲肽治疗，对照组（15例）采用垂体后叶素治疗，观察两组止血效果。结果奥曲肽组止血成功率91．9％，垂体后叶素组成功率64．2％。结论奥曲肽治疗食管静脉破裂出血疗效好。     

奥曲肽联合洛赛克治疗肝硬化食管胃底静脉曲张破裂出血疗效观察

目的观察奥曲肽联合洛赛克对于肝硬化食管胃底静脉曲张破裂出血的止血效果。方法奥曲肽0.1mg,静脉注射,然后用0.5mg加入5%葡萄糖盐水500ml中静脉滴注,24小时维持,直至粪便转黄。一般用药3天~5天。同时应用洛赛克20mg静脉注射,一日2次,待出血控制后逐步减量维持,一般用药时间7天~14天。并以垂体后叶素联合洛赛克治疗作为对照。结果治疗组73例病人,止血总有效率为94.5%,对照组为79.3%,两组比较有显著性差异(P<0.01)。结论奥曲肽联合洛赛克治疗肝硬化食管胃底静脉曲张破裂出血,止血迅速、疗效肯定、在临床上有一定应用价值。     

内镜套扎联合善宁治疗食管静脉曲张破裂出血疗效观察

目的探讨内镜下套扎联合善宁对食管静脉曲张治疗术后再出血的预防作用。方法选择112例食管静脉曲张患者,随机分为套扎组（A组）和套扎＋善宁组（B组）各56例,观察两组患者术后疗效以及并发症情况。结果B组的近期和远期再出血率、静脉曲张复发率、并发症以及门脉高压性胃病的发生率明显低于A组。结论套扎联合善宁治疗食管静脉曲张能有效降低食管静脉曲张术后再出血率。     

Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction

Endoscopic sclerotherapy is an effective treatment for bleeding esophageal varices, but it is associated with significant complications. Endoscopic ligation, a new form of endoscopic treatment for bleeding varices, has been shown to be superior to sclerotherapy in adult patients with cirrhosis. To determine the efficacy and safety of endoscopic sclerotherapy and ligation, the 2 methods were compared in a randomized control trial in 49 children with extrahepatic portal venous obstruction who had proven bleeding from esophageal varices. Twenty-four patients were treated with sclerotherapy and 25 with band ligation. No significant differences were found between the sclerotherapy and ligation groups in arresting active index bleeding (100% each) and achieving variceal eradication (91.7% vs. 96%, P =.61). Band ligation eradicated varices in fewer endoscopic sessions than did sclerotherapy (3.9 +/- 1.1 vs. 6.1 +/- 1.7, respectively, P <.0001). The rebleeding rate was significantly higher in the sclerotherapy group (25% vs. 4%, P =.049), as was the rate of major complications (25% vs. 4%, P =.049). After eradication, esophageal variceal recurrence was not significantly different in patients treated by ligation than by sclerotherapy (17.4% vs. 10%, P =.67). In conclusion, variceal band ligation in children is a safe and effective technique that achieves variceal eradication more quickly, with a lower rebleeding rate and fewer complications compared with sclerotherapy.     

Endoscopic treatments for portal hypertension

Endoscopic treatments for bleeding gastroesophageal varices include injection sclerotherapy, variceal obturation with tissue adhesives, and variceal rubber band ligation. Acute injection sclerotherapy remains a quick and simple technique for the control of active bleeding from esophageal varices. Although few trials have been published so far, some evidence suggests that the early administration of vasoactive drugs (somatostatin, octreotide, or terlipressin) is safe and may increase the efficacy of endoscopic treatments. Banding ligation is the optimal endoscopic treatment for the prevention of rebleeding from esophageal varices. The use of tissue adhesives and thrombin as injectates to treat bleeding fundal gastric varices and esophageal varices not responding to vasoactive drugs or sclerotherapy is promising but needs further assessment by means of randomized controlled trials. As of today, endoscopic treatments are not recommended for the primary prophylaxis of variceal bleeding.     

特利加压素联合内镜静脉曲张套扎术预防急性食管静脉曲张破裂再出血的研究

背景：食管胃底静脉曲张破裂出血是肝硬化的危重并发症之一,内镜静脉曲张套扎术（EVL）是食管静脉曲张破裂出血的首选内镜治疗方案。对于急性食管静脉曲张破裂出血患者,推荐于EVL术后使用血管活性药物特利加压素3—5d以预防早期再出血。目的：明确特利加压素联合EVL对急性食管静脉曲张破裂再出血的预防作用。方法：96例急诊食管静脉曲张破裂出血患者行EVL后随机分为2组,对照组口服普萘洛尔10mg／d×5d,干预组静脉推注特利加压素1mg／d×5d,其后两组患者均以维持剂量长期服用普萘洛尔。记录术后5d内和3个月内的再出血发生情况。结果：干预组早期（5d内）再出血率显著低于对照组（2．1％对12．5％,P〈0．05）,两组近期（3个月内）再出血率无明显差异（4．2％对14．6％,P〉0．05）。结论：急诊EVL联合特利加压素预防急性食管静脉曲张破裂早期再出血的效果优于EVL联合普萘洛尔,远期结果尚需进一步随访观察。     

A randomized, controlled trial of banding ligation plus drug therapy versus drug therapy alone in the prevention of esophageal variceal rebleeding

Background & Aims:  Both medications with beta-blockers and isosorbide-5-mononitrate and endoscopic variceal ligation have been proven plausible in the prevention of variceal rebleeding. However, the relative efficacy and safety of the combined treatment for preventing rebleeding remains unresolved.
Methods:  Patients with history of esophageal variceal bleeding were enrolled. Emergency ligation was performed in patients with acute variceal bleeding. After hemodynamic stability, eligible patients were randomized to either the Medication group, using nadolol plus isorsorbide-5-mononitrate, or the Combined group, receiving banding ligation in addition to medications. Patients in the two groups with rebleeding from esophageal varices were treated with band ligation. The end points were rebleeding from varices or death.
Results:  After a median follow up of 23 months, recurrent upper gastrointestinal bleeding developed in 51% in the Medication group and 38% in the Combined group ( P  = 0.21). Recurrent bleeding from esophageal varices occurred in 26 patients (43%) in the Medication group and in 16 patients (26%) in the Combined group ( P  = 0.07). Recurrent bleeding from gastroesophageal varices occurred in 48% of Medication group and 28% of Combined group ( P  = 0.05). The frequency of adverse effects and mortality rates were similar between both groups ( P  = 0.28).
Conclusions:  Combined ligation with medications was marginally more effective than medication alone in the prevention of gastroesophageal variceal rebleeding with similar adverse effects and mortality.     

Sclerotherapy versus banding in the treatment of variceal bleeding

Endoscopic sclerotherapy has been the mainstay in the management of esophageal variceal bleeding to control acute bleeding and decrease recurrent bleeding. Endoscopic variceal ligation is a new technique that is equally effective in the control of acute bleeding but achieves obliteration of varices in fewer treatment sessions with presumably less cost, results in a lower rebleeding rate, has fewer complications, and is associated with reduced mortality. Combination therapy with both endoscopic variceal ligation and endoscopic sclerotherapy appears to have no clear advantage over variceal ligation alone. On the basis of the results of a number of trials comparing sclerotherapy with band ligation, endoscopic variceal ligation has evolved to be the preferred first line modality for the endoscopic treatment of variceal bleeding.     

内镜静脉曲张结扎术与十四肽生长抑素治疗肝硬化食管静脉曲张破裂出血的疗效比较

目的 比较内镜静脉曲张结扎术与十四肽生长抑素在治疗肝硬化食管静脉曲张破裂出血中的效果.方法 将2003年1月至2006年4月广东省江门市中心医院消化科收治的80例肝硬化食管静脉曲张破裂出血患者分为内镜治疗组(40例)和十四肽生长抑素治疗组(40例).内镜治疗组在内镜下用多环连发皮圈结扎器行静脉曲张结扎术(EVL),然后静脉滴注垂体后叶素7 d;生长抑素治疗组先以十四肽生长抑素持续静脉滴注72 h,再以垂体后叶素静脉滴注持续4 d.结果 内镜治疗组中39例72 h内止血(97.5%).1个月内再出血4例(10%,其中1周内再出血3例),发生肝肾综合征1例,肝性脑病1例,死亡2例(5%).生长抑素治疗组72 h完全止血32例,1个月内再出血5例(12.5%),出现肝肾综合征5例(12.5%),P＞0.05;肝性脑病6例(15%),P＜0.05;死亡6例(15%),P＞0.05.结论 食管静脉曲张皮圈结扎治疗肝硬化食管静脉曲张破裂大出血优于生长抑素治疗,尽早EVL治疗能减少肝性脑病的发生.     

Do we need endoscopic sclerotherapy of oesophageal varices or the last turn off the light

For the primary prophylaxis of variceal bleeding endoscopic band ligation has been shown to be as effective as non-selective beta-blockers (carvedilol), but variceal injection sclerotherapy is not generaly recommended in this setting because of higher rate of complications and lower effect in reducing either bleeding or mortality. Endoscopic management of acutely bleeding gastroesophageal varices includes injection sclerotherapy, rubber band ligation, and variceal obturation with tissue adhesives. Variceal injection sclerotherapy remains a quick, simple and cheap technique for the control of active bleeding from esophageal varices, but is associated with more rebleeding than variceal band ligation, which is now preferred also for lower rate of complications. Endoscopic sclerotherapy has increasingly been replaced by ligation also in secondary prophylaxis of variceal bleeding. The studies showed that band ligation can eradicate varices in fewer sessions, re-bleeding and complications were fewer in comparison with variceal injection sclerotherapy. Because of the reduced efficacy, severe complications, and the high mortality associated with using conventional sclerosants in acute bleeding gastric varices, the technique of injecting tissue adhesives has been studied, described and used despite numerous complications. Endoscopic injection sclerotherapy of esophageal varices remains usable as an oldest method in arresting of this hemorrhage only in rare cases when the band ligation is not available.     

内镜套扎术在治疗食管静脉曲张破裂出血中的临床应用价值

目的探讨内镜下食管静脉曲张套扎术（EVL）治疗和预防肝硬化患者食管静脉曲张破裂出血的临床应用价值。方法回顾性分析2008-01～2012-01该院142例肝硬化食管静脉曲张破裂出血患者,其中行EVL治疗74例（治疗组）,内科保守治疗68例（对照组）,并对其临床疗效进行随访观察。结果所有患者随访6个月以上,治疗组的早期再出血率、迟发出血率、曲张静脉好转率、复发率、手术率及病死率均低于对照组（P〈0.05或〈0.01）。结论 EVL能有效地降低肝硬化门脉高压患者食管静脉曲张的程度,降低再出血率、复发率、手术率和病死率,是一种有效的内镜治疗手段。     

Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial

BACKGROUND AND AIMS: The transjugular intrahepatic portosystemic shunt (TIPS) is a new therapeutic modality for variceal bleeding. In this study we compared the two year survival and rebleeding rates in cirrhotic patients treated by either variceal band ligation or TIPS for variceal bleeding. METHODS: Eighty cirrhotic patients (Pugh score 7-12) with variceal bleeding were randomly allocated to TIPS (n=41) or ligation (n=39), 24 hours after control of bleeding. RESULTS: Mean follow up was 581 days in the ligation group and 678 days in the TIPS group. The two year survival rate was 57% in the TIPS group and 56% in the ligation group (NS); the incidence of variceal rebleeding after two years was 18% in the TIPS group and 66% in the ligation group (p<0.001). Uncontrolled rebleeding occurred in 11 patients in the ligation group (eight were rescued by emergency TIPS) but in none of the TIPS group. The incidence of encephalopathy at two years was 47% in the TIPS group and 44% in the ligation group (NS). CONCLUSIONS: TIPS did not increase the two year survival rate compared with variceal band ligation after variceal bleeding in cirrhotic patients with moderate or severe liver failure. It significantly reduced the incidence of variceal rebleeding without increasing the rate of encephalopathy.     

Variceal Band Ligation in the Prevention of Variceal Bleeding: A Multicenter Trial

Background/Aim:

Variceal bleeding is a life-threatening complication of portal hypertension with a high probability of recurrence. Treatment to prevent first bleeding or rebleeding is mandatory. The study has been aimed at investigating the effectiveness of endoscopic band ligation in preventing upper gastrointestinal bleeding in patients with portal hypertension and to establish the clinical outcome of patients.

Patients and Methods:

We analyzed in a multicenter trial, the efficacy and side effects of endoscopic band ligation for the primary and secondary prophylaxis of esophageal variceal bleeding. We assigned 603 patients with portal hypertension who were hospitalized to receive treatment with endoscopic ligation. Sessions of ligation were repeated every two to three weeks until the varices were eradicated. The primary end point was recurrent bleeding.

Results:

The median follow-up period was 32 months. A total of 126 patients had recurrent bleeding. All episodes were related to portal hypertension and 79 to recurrent variceal bleeding. There were major complications in 51 patients (30 had bleeding esophageal ulcers). Seventy-eight patients died, 26 deaths were related to variceal bleeding and 1 to bleeding esophageal ulcers.

Conclusions:

A great improvement in the prevention of variceal bleeding has emerged over the last years. However, further therapeutic options that combine higher efficacy, better tolerance and fewer side effects are needed.