肝硬化食管静脉曲张内镜下套扎临床疗效分析

目的 探讨内镜下套扎治疗肝硬化食管静脉曲张出血(esophageal varices bleeding,EVB)的止血效果及影响因素.方法 对123例肝硬化食管静脉曲张(esophageal varices,EV)出血的患者应用内镜下食管静脉套扎术(endoscopic variceal ligation,EVL)进行治疗.结果 所有患者经过1次EVL治疗,EV消失31例(25.2%),EV减轻92例(74.8%),无效0例.近期出血13例,远期出血9例.结论 EVL是治疗肝硬化食管静脉曲张破裂出血的一种有效方法,但并非没有风险,影响疗效因素众多.     

内镜下套扎与硬化夹心联合法治疗食管静脉曲张出血的研究

目的　了解套扎与硬化夹心联合法 (套扎 硬化 套扎 )能否获得优于单纯内镜下食管静脉曲张结扎 (EVL)的疗效。方法　对 98例肝硬化食管静脉曲张伴活动性出血或近期出血的患者随机采用单纯EVL或夹心法治疗 (EVL组 5 0例 ,夹心法组 4 8例 )。EVL组每条曲张静脉结扎皮圈不超过 3个 ,夹心法组每条曲张静脉结扎 2个皮圈 ,并在两个结扎点之间的曲张静脉内注射 1～ 3ml硬化剂。夹心法组 7例在首次内镜治疗时接受食管静脉造影检查。 7～ 10d重复 1次内镜治疗 ,直至静脉曲张消除。结果　 7例行静脉造影检查 ,其中 6例硬化剂在曲张静脉内滞留时间超过 4 5min。两种方法控制活动性食管静脉曲张出血 (EVB)的止血成功率相同 (10 0 .0 % ) ;两组间静脉曲张消除率相似 (夹心法组 93.8% ,EVL组 90 .2 % ,P >0 .0 5 ) ,但夹心法组一次治疗后静脉曲张消除率明显高于EVL组 (6 6 .7%比10 .0 % ,P <0 .0 0 1) ,达到消除的平均治疗次数明显减少 (1.2± 0 .4比 3.8± 1.5 ,P <0 .0 1) ,所需时间显著缩短 [(13.1± 4 .3)d比 (42 .5± 16 .7)d ,P <0 .0 1];与EVL组相比 ,夹心法组再出血率较低 (8.3%比2 8.0 % ,P <0 .0 5 ) ,随访期内静脉曲张复发率明显下降 (8.3%比 4 4 .0 % ,P <0 .0 0 5 ) ;两组间并发症发生率相似 (夹心法组 1     

肝硬化食管静脉曲张出血的急诊内镜下套扎治疗

目的 探讨急诊内镜下紧急套扎治疗肝硬化食管静脉曲张(EV)破裂出血的安全性及止血效果。方法 对89例肝硬化EV出血患者在急诊状态下紧急内镜套扎,监测套扎术前、术中及结束时血压、心率、呼吸变化,观察套扎过程对生命体征的影响。结果 急诊止血成功率达98.9％,套扎过程对生命体征无明显影响(P均>0.05),术中无并发症发生。近期再出血2例。肝硬化患者76例随访3-30个月,死亡11例,病死率14.5％。结论 紧急EVL治疗肝硬化EV破裂出血是一种安全、有效、快捷的止血方法。     

内镜治疗食管静脉曲张方法的临床研究

食管静脉曲张(EV)破裂出血是肝硬化门脉高压症最凶险的并发症。内镜食管静脉硬化术(EVS)和内镜食管静脉套扎术(EVL)是治疗食管静脉曲张出血的首选方法，但越来越多的临床研究显现出两者各有利弊，为此我们采用EVL EVS EVL联合方法(夹心法)治疗食管静脉曲张破裂出血，并将3种方法的临床效果进行对比研究，现报告如下。     

食管静脉曲张出血内镜下结扎治疗的临床疗效分析

我们应用内镜下结扎器对653例食管静脉曲张破裂出血者进行了1 330例次食管静脉曲张结扎术(EVL),并对EVL后食管静脉曲张(EV)消失率、急诊止血率、再出血率、EV复发率及并发症等进行了随访研究。 一、资料与方法 1.对象:1993年10月至2002年5月选择经胃镜诊断的食管静脉曲张出血患者653例行EVL治疗,男523例,女     

内镜注射组织胶治疗重度食管胃底静脉曲张破裂出血疗效观察

对于门脉高压引起的食管胃底静脉曲张患者,由于食管静脉曲张内镜下套扎治疗(EVL)及内镜下硬化治疗(DVS)等技术的日趋成熟,单纯的食管静脉曲张(EV)破裂出血患者,一般经内镜可得到有效的治疗,但并发胃底静脉曲张(GV)”破裂出血患者,目前临床上尚缺乏理想的治疗手段。为使EV及GV患者得到更为有效的治疗,我院自1999年2月至2000年8月,开展内镜下连续套扎术治疗食管胃底静脉曲张23例,对其中4例并发重度GV破裂出血患者,联合内镜下行组织粘合剂注射治疗,取得理想疗效,现报告如下。     

食管静脉曲张出血内镜套扎术远期疗效观察

近年来国内外研究资料表明,应用内镜套扎术(EVL)对食管静脉曲张(EV)破裂出血(EVB)有良好的急性止血和预防再出血的效果,但多数报告随访时间仅仅1年左右。因此,人们的印象是,EVL的止血效果是暂时的,EV会反复出现,需要反复进行内镜治疗。本文旨在探讨经内镜定期随访,评估EVL能否达到长期止血的目的。 1 对象和方法 1.1 临床资料 近年来我院使用EVL治疗肝硬化并发EVB共481例。选择以下病例作为研究对象:①经EVL治疗后食管静脉曲张(EV)已消失或≤Ⅰ度者。②坚持内镜随访至少1年以上。③合并原发性肝癌、肝肾综合征或者EVL后接受门腔静脉分流术者除外。入选对象共74例。其中男56例,女18例,年龄24～69岁,平均45.8岁。肝功能Child-Pugh     

不同时间间隔内镜下套扎术治疗肝硬化食管静脉曲张出血的疗效观察

目的比较1周与2周间隔内镜下静脉曲张套扎术(EVL)治疗肝硬化食管静脉曲张(EV)出血(EVB)的临床疗效。方法纳入肝硬化EVB且初次EVL成功止血患者,随机分为1周间隔(A组,44例)和2周间隔组(B组,43例),分别每周和每2周行EVL,比较两组EV消失率、EVB复发率、EV消失所需时间、套扎次数、内镜检查次数及并发症情况。结果 A组4周时总EV消失率及套扎延迟次数显著高于B组、EV消失所需周数显著低于B组(P0.05),两组EVB复发率、EV消失所需套扎次数、内镜次数及并发症发生率无差异(P0.05)。结论与2周间隔相比,1周间隔EVL治疗肝硬化EVB能更快速地达到EV消失的目的,但仍需大样本、多中心临床研究进一步验证。     

硬化剂在肝硬化食管静脉曲张破裂出血防治中的优化应用

约50%的肝硬化患者初诊时即存在食管胃静脉曲张,尤以食管静脉曲张(EV)常见,且EV的发生率随肝脏疾病严重程度增加而增高(Child-Pugh A 43%、Child-Pugh B 71%、Child-Pugh C 76%)[1]。<5 mm的EV以每年10%的速度进展为大的EV,小EV的年出血率为5%,而大EV可达15%,EV出血后6周内死亡率高达20%[2-4]。急性EV破裂出血停止后再次出血率和死亡率较高,未进行二级预防的EV患者1~2年内再次出血率高达60%,死亡率高达33%[5]。因此EV破裂出血的防治非常重要,内镜干预在EV破裂出血的防治中起重要作用,包括内镜下静脉曲张套扎术(EVL)、内镜下硬化剂注射治疗(EIS)、自膨式金属支架等[5-6]。本文就EIS在EV破裂出血的防治作用做一述评。     

不同治疗方案在肝硬化食管静脉曲张破裂出血中的应用比较

目的比较内镜套扎术(EVL)联合西药、EVL联合中西药两种方案治疗肝硬化食管静脉曲张破裂出血的临床疗效。方法按随机数表法将60例肝硬化食管静脉曲张破裂出血患者分为A组(EVL联合西药组,n=30)和B组(EVL联合中西药组,n=30)。患者均随访6个月。观察临床疗效,于治疗前及治疗第5天检测两组患者血管内皮功能相关指标[血清血管紧张素转换酶(ACE)、一氧化氮(NO)]及肝功能指标[谷草转氨酶(AST)、谷丙转氨酶(ALT)]水平,记录治疗期间不良反应情况。结果 A组EVL术前止血率小于B组(P 0. 05),两组72 h止血率差异无统计学意义(P 0. 05)。A组早期再出血发生率大于B组(P 0. 05)。两组迟发再出血发生率、病死率、总不良反应发生率差异无统计学意义(P 0. 05)。治疗第5天,两组血清ACE、NO、AST、ALT水平均较治疗前降低,且B组低于A组,差异均有统计学意义(P 0. 05)。结论 EVL联合中西药方案治疗肝硬化食管静脉曲张破裂出血止血效果良好,并有助于减轻患者血管内皮损伤,改善其肝功能,安全性良好,较EVL联合西药更具优势。     

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.     

经内镜栓塞术联合套扎术治疗食管胃底静脉曲张出血的疗效观察

目的探讨胃底静脉曲张栓塞术联合内镜下食管静脉曲张套扎术（EVL）治疗肝硬化上消化道出血的疗效。方法经急诊胃镜检查发现活动性胃底静脉曲张出血合并Ⅱ°以上食管静脉曲张且排除其他病因的上消化道出血患者共156例,分为治疗组和对照组,治疗组胃底静脉曲张组织粘合剂栓塞同时食管静脉EVL治疗;对照组胃底静脉曲张组织粘合剂栓塞治疗2个月后行食管静脉EVL。结果两组均未发生与治疗相关的并发症。止血成功率治疗组为96．3％（77／80）,对照组为97．4％（74／76）,（P〉0．05）;近期再出血率治疗组为6．4％（5／78）,对照组为21．3％（16／75）,两组差异有统计学意义（P〈0．05）;两组患者随访6个月,再出血率分别为13．0％（9／69）、25．4％（17／67）,差异有统计学性意义（P〈0．05）。胃底静脉曲张改善总有效率治疗组和对照组分别为61．6％、59．1％,食管曲张静脉改善总有效率为74．0％、67．9％,差异均无统计学意义。结论胃底静脉曲张栓塞联合EVL是治疗肝硬化胃底静脉曲张出血并食管静脉曲张的安全有效方法,同时联合治疗更能降低再出血率。     

心得安联合内镜套扎术预防食管静脉曲张再出血的疗效分析

目的比较心得安联合内镜套扎治疗与单独内镜套扎治疗预防食管静脉曲张再出血的疗效。方法 65例食管静脉曲张破裂出血的患者随机分为心得安联合内镜套扎治疗组(33例),单独内镜套扎治疗组(32例),平均随访12个月,比较两组间再出血率,门脉高压性胃病,食管静脉曲张复发和胃底静脉曲张的发生率。结果两组治疗后随访第6,12个月显示,与单独内镜套扎治疗比较,心得安联合内镜套扎治疗显著降低再出血率(15.2%vs 37.5%,21.2%vs 46.9%,P<0.05),门脉高压性胃病(18.2%vs43.8%,30.3%vs 56.3%,P<0.05),食管静脉曲张复发(15.2%vs 37.5%,24.2%vs 50.0%,P<0.05)和胃底静脉曲张的发生率(12.1%vs 34.4%,21.2%vs 46.9%,P<0.05)。结论心得安联合内镜套扎治疗是二级预防食管静脉曲张出血的首选治疗方法。     

心得安单纯或联合使用在二级预防食管静脉曲张出血中的疗效比较

目的比较单纯心得安、套扎＋心得安、硬化剂＋心得安二级预防食管静脉曲张出血的疗效,探寻心得安二级预防食管静脉曲张出血的最佳组合。方法78例食管静脉曲张出血患者随机分成3组,每组26例,止血后分别给予心得安（心得安组）、套扎＋心得安（套扎组）、硬化剂＋心得安（硬化剂组）,比较各组12个月内再出血率、死亡率,以及各组门脉高压性胃病、胃底静脉曲张发生率、食管曲张静脉复发率。结果12个月内再出血率套扎组为30．77％,明显低于心得安组（53．85％）及硬化组（42．31％）（P均〈0．05）;套扎组和心得安组门脉高压性胃病及胃底静脉曲张发生率相似,都明显低于硬化组（P均〈0．05）;而食管静脉曲张再发率高于硬化组（P〈0．05）。结论在应用心得安的基础上进行套扎治疗可能是目前食管静脉曲张出血最有效的二级预防方法。     

内镜下套扎术预防肝硬化食管静脉曲张破裂出血的远期随访观察

目的 观察肝硬化食管静脉曲张患者分别行食管静脉曲张套扎术(endoscopic variceal ligation,EVL)和口服普萘洛尔后的再出血发生率、死亡率、治疗前后静脉曲张程度以及肝功能分级变化.方法 共纳入患者118例,其中66例采用EVL治疗,52例采用药物预防治疗.EVL 治疗组给予多次套扎,直到曲张静脉消失;药物治疗组给予普萘洛尔,起始剂量10 mg,每日2次,逐渐增至最大耐受剂量.对所有患者随访20个月,观察比较两组出血发生率和死亡率、治疗前后静脉曲张程度以及肝功能分级变化.结果 EVL治疗组有效随访58例,其问发生出血7例(12.1%),死亡2例(3.4%);药物治疗组有效随访46例,期间发生出血14例(30.4%),死亡6例(13.0%),两组间差异有统计学意义(P<0.05).EVL治疗组总静脉消失率为41.3%(24/58),药物治疗组46例曲张静脉均未消失;比较两组治疗前后肝功能未见明显变化(P>0.05).结论 与服用普萘洛尔相比,EVL能显著降低出血率、死亡率和静脉曲张程度,且对肝功能无明显损害作用.     

Influence of endoscopic variceal ligation on oesophageal motility

BACKGROUND: To determine the change of oesophageal manometry in patients with oesophageal varices before and after oesophageal variceal ligation (EVL). METHODS: Forty-five patients who had liver cirrhosis and oesophageal varices with high risk of bleeding were managed by EVL. Oesophageal manometry was performed just prior to the ligation and 4-6 weeks after obliteration of varices. Another 45 age- and sex-matched patients without hepatic, oesophageal or systemic disease served as the control group. RESULTS: At 5 cm above the lower oesophageal sphincter (LES), the amplitude of the contractive wave was significantly lower in patients before EVL (56.9 +/- 31.8 vs 80.1 +/- 30.1, P< 1.05) and returned to the level of control subjects after EVL (76.5 +/- 37.0 vs 80.1 +/- 30.1, P> 0.05). At 10 cm above LES, the amplitude of the contractive wave was significantly lower in patients before and after EVL than the control group (54.3 +/- 29.2 vs 68.1 +/- 29.5, 54.2 +/- 26.0 vs 68.1 +/- 29.5, respectively, P< 0.05). The percentage of tertiary waves was significantly higher in patients before and after EVL than in the control group (31.4 +/- 36.6 vs 5.8 +/- 15.1, 26.9 +/- 32.9 vs 5.8 +/- 15.1, respectively, P< 0.05). However, no significant swallowing disturbance was noted in patients after EVL. There was significantly greater LES length in patients before EVL (4.0 +/- 0.9 vs 3.4 +/- 0.7, P<0.05) but there was no significant difference in the LES length after EVL as compared with the control group. Eighty-six per cent (39/45) of patients developed paraoesophageal varices and 31% (14/45) developed new varices 6 months after variceal obliteration. However, there was no significant difference in manometry at the time of variceal obliteration between patients with variceal recurrence and those without. CONCLUSIONS: The presence of varices affected oesophageal motility. However, such abnormality had little clinical significance. Endoscopic variceal ligation normalized oesophageal motility and may not induce abnormal oesophageal motility. The manometric change can not be used to predict the recurrence of varices in cirrhotic patients after variceal obliteration.     

Endoscopic variceal ligation versus propranolol in prophylaxis of first variceal bleeding in patients with cirrhosis

BACKGROUND AND AIM: To compare the efficacy and safety of endoscopic variceal ligation (EVL) with propranolol in prophylaxis on the rate of first esophageal variceal bleeding in patients with cirrhosis. METHODS: A prospective, randomized trial was conducted in 100 cirrhotic patients with no history of previous upper gastrointestinal bleeding and with esophageal varices endoscopically judged to be at high risk of hemorrhage. The end-points of the study were bleeding and death. RESULTS: Life-table curves showed that prophylactic EVL and propranolol were similarly effective for primary prophylaxis of variceal bleeding (11/50 [22%]vs 12/50 [24%]; P = 0.68) and overall mortality (14/50 [28%]vs 12/50 [24%]; P = 0.49). The 2-year cumulative bleeding rate was 18% (9/50) in the EVL group and 16% (8/50) in the propranolol group. The 2-year cumulative mortality rate was 28% (14/50) in the EVL group and 24% (12/50) in the propranolol group. Comparison of Kaplan-Meier estimates of the time to death of both groups showed no significant difference in mortality in both groups (P = 0.86). Patients undergoing EVL had few treatment failures and died mainly of hepatic failure. In the propranolol group, the mean daily dosage of the drug was 68.2 +/- 32.8 mg, which was sufficient to reduce the pulse rate by 25%. 20% of patients withdrew from propranolol treatment due to adverse events. CONCLUSIONS: Prophylaxis EVL is as effective and as safe as treatment with propranolol in decreasing the incidence of first variceal bleeding and death in cirrhotic patients with high-risk esophageal varices.     

Improved Prognosis of Cirrhosis Patients with Esophageal Varices and Thrombocytopenia Treated by Endoscopic Variceal Ligation Plus Partial Splenic Embolization

The aim of this study was to assess the efficacy of the combination of endoscopic variceal ligation (EVL) and partial splenic embolization (PSE) compared with EVL alone in cirrhosis patients with thrombocytopenia. In a prospective study, 84 cirrhosis patients with esophageal varices and thrombocytopenia (platelet count < 50,000/mm(3)) underwent EVL plus PSE (N = 42) or EVL alone (N = 42). Primary end points assessed during the follow-up period included the recurrence of varices, progression to variceal bleeding, and death. Comparison between combined treatment and variceal ligation alone by multivariate analysis showed a hazard ratio of 0.44 for the recurrence of varices (P = 0.02), 0.19 for progression to variceal bleeding (P = 0.01), and 0.31 for death (P = 0.04). These results suggest that the combination of EVL plus PSE can prevent the recurrence of varices, progression to variceal bleeding, and death in cirrhosis patients with esophageal varices and thrombocytopenia.     

Comparison of characteristics of recurrent esophageal varices after endoscopic ligation versus endoscopic ligation plus sclerotherapy

BACKGROUND/AIMS: The characteristics of recurrent esophageal varices after endoscopic variceal ligation (EVL) plus endoscopic injection sclerotherapy (EIS) versus EVL alone, including the number of additional treatments and patterns of recurrence have been compared. METHODOLOGY: Thirty-four patients with cirrhosis and esophageal varices were treated by EVL alone (EVL group), and 46 patients were treated by EVL followed by extravariceal injection sclerotherapy (EVL+extraEIS group). RESULTS: Fewer treatment sessions were needed (p<0.005), and more O-rings were required (p<0.0001) in the EVL group than in the EVL+extraEIS group. The 1- and 3-year cumulative recurrence rates were higher in the EVL group (81.3% and 93.8%) than in the EVL+extraEIS group (62.8% and 91.5%) (p<0.05). Endoscopic examination at first recurrence showed varices of a more severe form (p<0.001), but less frequently having the red color sign (p<0.0001), and intramucosal venous dilatation (p<0.0001) in the EVL group than in the EVL+extraEIS group. The number of rehospitalizations for additional treatment was lower (p<0.0001) and more patients could be managed with only endoscopic treatment for recurrent varices in the EVL group than in the EVL+extraEIS group (p<0.05). CONCLUSIONS: Even if the overall rate of variceal recurrence was higher, fewer treatment sessions were needed, and the number of rehospitalizations for these additional treatments was lower in the EVL group than in the EVL+extraEIS group. Multiple sessions of EVL are an effective strategy for the treatment of esophageal varices.