Effect of intravariceal sclerotherapy combined with esophageal mucosal sclerotherapy using small-volume sclerosant for cirrhotic patients with high variceal pressure

AIM: To explore the effect of intravariceal-mucosal sclerotherapy using small dose of sclerosant on the recurrence of esophageal varices.METHODS: We randomly assigned 38 cirrhotic patients with previous variceal bleeding and high variceal pressure (> 15.2 mmHg) to receive endoscopic variceal ligation (EVL) and combined intravariceal and esophageal mucosal sclerotherapy (combined group) using small-volume sclerosant. The end-points of the study were rebleeding and recurrence of esophageal varices.RESULTS: During a median follow-up period of 16 mo, varices recurred in 1 patient in the combined group as compared with 7 patients in the EVL group (P = 0.045). Rebleeding occurred in 3 patients in the EVL group as compared with 1 patient in the combined group (P = 0.687). No patient died in the two groups. No significant differences were observed between the two groups with respect to serious adverse events.CONCLUSION: Intravariceal-mucosal sclerotherapy using small dose of sclerosant is more effective than EVL in decreasing the incidence of variceal recurrence for cirrhotic patients.     

内镜下套扎联合硬化剂注射治疗乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者疗效及其再出血危险因素分析*

目的 研究内镜下套扎联合硬化剂注射治疗乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血（EGVB）患者的疗效,并分析引起治疗后再出血的危险因素。 方法 2012年2月~2016年2月收治的120例乙型肝炎肝硬化并发EGVB患者,采用内镜下食管静脉曲张套扎术（EVL）联合内镜下静脉曲张硬化剂注射术（EIS）治疗,对胃底静脉曲张出血患者采用组织黏胶内镜下注射联合EIS治疗,术后给予心得安治疗。采用Logistic回归分析再出血的危险因素。 结果 在手术过程中止血成功率为100.0%,33例EGVB1型患者治疗后静脉曲张消失率明显高于而静脉曲张复发率显著低于2型或1型/2型患者（P<0.05）;不同类型静脉曲张患者治疗后再出血率比较无显著性差异（P>0.05）;35例再出血患者男性占（85.7%）,明显高于85例未再出血组的49.4%（P<0.05）,年龄明显大于未出血患者（P<0.05）,门静脉内径和Child-Pugh评分分别为（1.5±0.5）cm和（10.3±2.1）分,显著高于未出血患者[分别为（1.1±0.2） cm和（7.3±1.3） 分,P<0.05],而血清白蛋白和血钠浓度分别为（23.4±5.5） g/L和（124.67±31.47） mmol/L,显著低于未出血患者[（33.6±6.7）g/L和（137.5±36.2） mmol/L,P<0.05];经Logistic回归分析,发现门静脉内径和Child-Pugh评分是诱发再出血的危险因素[OR=3.713（1.253~10.999）、OR=4.267（1.311~13.886）],而白蛋白水平和血钠浓度是再出血发生的保护因素[OR=0.236（0.062~0.902）、OR=0.143（0.026~0.785）]。 结论 内镜下套扎联合硬化剂注射治疗乙型肝炎肝硬化并发EGVB患者临床疗效显著,并且对EGVB1型患者疗效最好。门静脉内径宽或Child-Pugh评分高说明肝储备功能差,发生再出血的风险就大。因此,针对这样的患者,更应该做好防治再出血治疗。     

肝硬化食管胃静脉曲张破裂出血行规律内镜下治疗的临床价值

目的　评价肝硬化食管胃静脉曲张破裂出血（esophagogastric variceal bleeding,EGVB）患者行规律内镜下治疗的临床价值。方法　2015年1月—2018年1月,在南京鼓楼医院行内镜下止血治疗的305例肝硬化EGVB病例纳入回顾性队列研究,按是否规律内镜下治疗分成2组,即规律内镜治疗组（n=145）和未规律内镜治疗组（n=160）,主要观察指标为再出血率,次要观察指标为随访时间、再出血间隔时间和再出血死亡率。结果　2组患者在性别构成、平均年龄、病因构成、病因是否控制、肝脏储备功能、是否服用非选择性β受体阻滞剂等方面差异均无统计学意义（P>0.05）,基线资料具有可比性。再出血率规律内镜治疗组为11.7%（17/145）,未规律内镜治疗组为41.9%（67/160）（χ2=38.74,P<0.001）;随访时间规律内镜治疗组为（28.14±11.11）个月,未规律内镜治疗组为（21.10±12.37）个月（t=5.21,P<0.001）;再出血间隔时间规律内镜治疗组为12.0（6.0,23.0）个月,未规律内镜治疗组为1.0（1.0,6.0）个月（U=164.00,P<0.001）;再出血死亡率规律内镜治疗组为1.4%（2/145）,未规律内镜治疗组为10.6%（17/160）（χ2=11.13,P=0.001）。结论　相较于未行规律内镜下治疗者,肝硬化EGVB患者行规律内镜下治疗更具临床意义,可显著降低再出血率、延长再出血时间间隔、减少再出血死亡率。     

内镜下食管静脉曲张套扎术治疗乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者再出血风险观察*

目的 研究采用内镜下食管静脉曲张套扎术(EVL)治疗乙型肝炎肝硬化(LC)并发食管静脉曲张(EV)破裂出血患者治疗后再出血的风险。方法 2016年4月～2019年10月我科诊治的178例乙型肝炎肝硬化并发食管静脉曲张破裂出血(EVB)患者,在止血后采用EVL治疗,随访再出血发生情况,应用Cox风险回归模型进行多因素分析,建立Nomogram模型,预测再出血。结果 178例患者急性出血后,死亡12例(6.7%),166例接受EVL术,均获得成功;术后随访12～54个月,27例(16.3%)发生再出血;入院时,27例再出血组外周血Hb和血清白蛋白水平显著低于139例未再出血组(P<0.05),而空腹血糖(FPG)和糖化血红蛋白(HbA1c)水平显著高于未再出血组,差异均有统计学意义(P<0.05);入院止血后检查,发现再出血患者门静脉和脾静脉宽度显著大于未再出血组(P<0.05);Cox风险模型分析显示Child-Pugh分级(95%CI=1.125～3.439,HR=1.967,P=0.018)、腹水(95%CI=1.754～2.329,HR=2.021,P=0.000)、HbA1c(95%CI=1.173～1.921,HR=1.501,P=0.001)、FPG(95%CI=1.379～3.152,HR=2.085,P=0.000)和肝性糖尿病(95%CI=1.321～2.945,HR=2.076,P=0.006)是EVL术后再出血的独立影响因素;根据Cox建立Nomogram模型,ROC分析结果显示Nomogram判断术后再出血的AUC为0.804(SE=0.053,95%CI=0.700～0.907,P=0.000),其敏感度为0.857,特异度为0.565。结论 采取EVL治疗LC并发EVB患者术后再出血发生率较高,除常见的风险因素外,伴有肝性糖尿病也可能是重要的原因,临床应加强对血糖的控制,减少再出血的发生。     

Role of band ligation for secondary prophylaxis of variceal bleeding

AIM To summarize and critically examine the role of band ligation in secondary prophylaxis of variceal bleeding in patients with cirrhosis. METHODS A literature review was performed using the MEDLINE and PubM ed databases. The search terms consisted of the words "endoscopic band ligation" OR "variceal band ligation" OR "ligation" AND "secondary prophylaxis" OR "secondary prevention" AND "variceal bleeding" OR "variceal hemorrhage" AND "liver cirrhosis". The data collected from relevant meta-analyses and from the most recent randomized studies that were not included in these meta-analyses were used to evaluate the role of endoscopic band ligation in an effort to demonstrate the most recent advances in the treatment of esophageal varices. RESULTS This study included 11 meta-analyses published from 2002 to 2017 and 10 randomized trials published from 2010 to 2017 that evaluated the efficacy of band ligation in the secondary prophylaxis of variceal bleeding. Overall, the results proved that band ligation was superior to endoscopic sclerotherapy. Moreover, the use of β-blockers in combination with band ligation increased the treatment effectiveness, supporting the current recommendations for secondary prophylaxis of variceal bleeding. The use of transjugular intrahepatic portosystemic shunt was superior to combination therapy regarding rebleeding prophylaxis, with no difference in the survival rates; however, the results concerning the hepatic encephalopathy incidence were conflicting. Recent advances in the management of secondary prophylaxis of variceal bleeding have targeted a decrease in portal pressure based on the pathophysiological mechanisms of portal hypertension.CONCLUSION This review suggests that future research should be conducted to enhance current interventions and/or to develop innovative treatment options with improved clinical endpoints.     

内镜与生长抑素联合治疗食管静脉曲张出血

目的　观察内镜下治疗和生长抑素（ Ｓ Ｓ）联合对食管静脉曲张出血的短期止血效果。方法　病人分二组, Ｓ Ｓ组在急诊内镜前后连续用 Ｓ Ｓ ５ 天;联合组在 Ｓ Ｓ基础上加行内镜下硬化剂或套扎,但内镜４８ 小时后停用 Ｓ Ｓ。结果　硬化剂３７ 例和套扎３２ 例共计６９ 例的联合组与６４ 例 Ｓ Ｓ组间具可比性。在需气囊压迫、最初止血率、再出血率和死亡率方面,联合组的效果显著优于 Ｓ Ｓ组。二组间的输出血量差异不显著。结论　与单纯 Ｓ Ｓ治疗相比,内镜治疗和 Ｓ Ｓ联合可减少气囊压迫的需求,提高止血率,降低再出血率,进而降低死亡率。     

糖尿病对肝硬化食管静脉曲张内镜治疗后再出血影响的临床研究

目的探讨合并糖尿病是否影响肝硬化食管静脉曲张患者内镜治疗后的再出血。方法2015年6月至2018年3月,因肝硬化食管静脉曲张破裂出血在安徽医科大学第一附属医院接受内镜下静脉曲张套扎术或内镜下硬化剂注射术初次治疗的207例病例纳入回顾性分析,以术后6个月作为观察结束点统计再出血情况,根据有无出血分为出血组(n=54)和未出血组(n=153),对于可能导致术后再出血的影响因素先行单因素分析,发现差异性后再行Logistic回归分析。结果单因素分析发现,性别构成、年龄、有无门静脉血栓、有无吸烟史、有无饮酒史(P=0.05)、有无高血压、血小板计数、总胆红素水平、白蛋白水平、谷丙转氨酶水平、凝血酶原时间、食管静脉曲张程度构成、手术方式构成在出血组和未出血组间差异均无统计学意义(P均≥0.05),是否合并糖尿病、血红蛋白水平、血糖水平、腹水程度构成、肝功能分级构成在出血组和未出血组间差异均有统计学意义(P均<0.05)。将合并糖尿病(是/否)、血红蛋白水平、血糖水平、腹水程度(无-轻度/中-重度)、肝功能Child-Pugh分级(A级/B-C级)以及饮酒史(有/无)纳入多因素分析,结果显示合并糖尿病是肝硬化食管静脉曲张内镜治疗后再出血的独立危险因素(P=0.008,OR=2.973,95%CI:1.322~6.689)。结论合并糖尿病的肝硬化食管静脉曲张患者内镜治疗后易发生再出血。     

内镜套扎术联合生长抑素治疗肝硬化并发食管静脉曲张出血患者临床效果和安全性分析*

目的 分析采用内镜下曲张静脉套扎术联合生长抑素治疗肝硬化并发食管静脉曲张破裂出血患者的临床治疗效果和安全性。方法 2015年4月~2017年5月我院收治的肝硬化并发食管静脉曲张破裂出血患者64例,被分为两组,每组32例。在对照组,给予奥美拉唑和奥曲肽治疗,观察组则在上述治疗12 h后,给予内镜下曲张静脉套扎术治疗。结果 在治疗1 w末,观察组止血总有效率为100.0%,显著高于对照组的90.6%（P<0.05）,对照组死亡3例;治疗后,观察组肝静脉压力梯度（HVPG）为（6.5±1.0） mmHg,显著低于对照组的（11.9±1.1） mmHg,而RBC为（4.7±0.5）×10¹²/L,Hb为（118.5±23.1） g/L,显著高于对照组[分别为（4.1±0.4）×10¹²/L和（104.4±22.5） g/L,P<0.05]; 观察组止血时间为（1.3±0.4）d、输血量为（1.7±1.0） U、住院日为（20.4±3.5） d,显著短于或少于对照组[分别为（2.8±0.5） d、（2.8±1.5） U和（29.8±4.0） d,P<0.05];进行为期1年的随访,观察组再出血发生率为53.1%,显著低于对照组的86.2%（P<0.05）。结论 针对肝硬化并发食管静脉曲张出血患者,采用内镜套扎术联合生长抑素治疗可有效止血,缩短住院时间,止血迅速,治疗后再出血发生率低,且安全性较高。     

奥曲肽联合内镜套扎术治疗食管静脉曲张破裂出血的疗效观察

目的观察奥曲肽联合内镜套扎术对食管静脉曲张破裂出血的治疗效果。方法30例病人随机分为两组,内镜治疗前分别给予奥曲肽或垂体后叶素,然后行内镜套扎治疗。观察两组的止血率、再出血率和不良反应发生率。结果奥曲肽组与垂体后叶素组相比,止血率明显提高,再出血率和不良作用明显下降(P<0.05),治疗效果明显优于后者。结论奥曲肽联合内镜套扎术可以明显提高食管静脉曲张破裂出血的治疗效果和安全性。     

The value of the endoscopic therapies in the treatment of rectal varices: a retrospective comparison between injection sclerotherapy and band ligation.

This study consisted of 15 patients who had undergone endoscopic injection sclerotherapy (EIS) or endoscopic variceal ligation (EVL) for rectal varices. Ten of fifteen patients had histories of anal bleeding, and colonoscopy revealed signs of the risk of variceal rupture in the other five patients. EIS was perfomed in six of the fifteen patients, and the other nine patients underwent EVL. EIS was performed weekly from 2 to 4 times (mean, 3.0), and the total amount of sclerosant ranged from 3.2 to 5.8ml (mean, 4.9ml). After EIS, colonoscopy revealed shrinkage of the rectal varices in all six patients with no complications. EVL was performed weekly from 1 to 3 times (mean, 2.2), and bands were placed on the varices at 2-12 sites (mean, 8.0). After EVL, colonoscopy revealed both ulcers and shrinkage of the varices in the rectum in all nine patients. Eight of the nine experienced no operative complications. However, in the other case, colonoscopy revealed bleeding from ulcers after EVL. The average follow-up period after EIS or EVL was 30 months. The overall non-recurrence rate of rectal varices was 11 of 15 (73.3%); this includes five of the six patients (83.3%) receiving EIS and six of the nine who received EVL (66.7%). The non-recurrence rate was no difference between EIS group and EVL group statistically (P=0.57) by reason of small number of cases. In conclusion, EIS is some superior to EVL with regard to long-term effectiveness, complications on rectal varices.     

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。     

内镜套扎术急症止血治疗肝硬化食管静脉曲张破裂出血的疗效观察

目的探讨食管静脉曲张破裂出血的内镜套扎术急诊止血的疗效及安全性。方法对52例乙型肝炎肝硬化食管静脉曲张破裂出血患者实施内镜下急诊套扎止血术,观察术中、术后并发症,并于术后1月复查胃镜观察食管曲张静脉消失情况。结果51例（98％）患者急诊止血成功,1例（2％）止血失败,表现为术后6天内反复便血,转外科手术治疗;术后1月复查胃镜见21例（41．2％）静脉曲张消失或基本消失,28例（54．9％）中上段食管静脉曲张基本消失,2例（3．9％）存在显著的静脉曲张。术后常见并发症有咽下不适、胸骨后隐痛、低至中度发热,发生率为15．9％,未发生严重的并发症。结论急诊套扎术治疗食管静脉曲张破裂出血疗效可靠、安全性高。     

结扎和硬化疗法治疗肝硬化食管静脉曲张出血疗效比较的荟粹分析

目的:对套扎疗法与硬化疗法治疗肝硬化食管静脉曲张出血的疗效进行系统评价．方法:通过Medline、EMBase和中国期刊全文数据库检索1985-01／2005-11发表的有关硬化疗法与套扎疗法治疗肝硬化食管静脉曲张出血相关文献,并采用RevMan4．2．8进行Meta分析．结果:按照入选标准,有7项前瞻性随机对照临床试验纳入．Meta分析结果显示,硬化疗法在治疗肝硬化食管静脉曲张中的再出血率高于套扎疗法(RR=1．32,95％CI:1．10-1．57, P<0．05);而在降低死亡率方面二者相似(RR= 1．24,95％CI:0．99-1．55,P>0．05)．结论:套扎疗法较硬化疗法在治疗肝硬化食管静脉曲张中能更好的预防再出血,在降低死亡率方面无差异．     

Efficacy of β-adrenergic blocker plus 5-isosorbide mononitrate and endoscopic band ligation for prophylaxis of esophageal variceal rebleeding： A meta-analysis

AIM： TO systematically assess the efficacy and safety of β-adrenergic blocker plus 5-isosorbide mononitrate（BB ＋ ISMN） and endoscopic band ligation （EBL） on prophylaxis of esophageal variceal rebleeding.METHODS： Randomized controlled trials （RCTs）comparing the efficacy and safety of BB ＋ ISMN and EBL on prophylaxis of esophageal variceal rebleedingwere gathered from Medline, Embase, Cochrane Controlled Trial Registry and China Biological Medicine database between January 1980 and August 2007.Data from five trials were extracted and pooled. The analyses of the available data using the Revman 4.2 software were based on the intention-to-treat principle.RESULTS： Four RCTs met the inclusion criteria. Incomparison with BB ＋ ISMN with EBL in prophylaxisof esophageal variceal rebleeding, there was nosignificant difference in the rate of rebleeding [relativerisk （RR）, 0.79; 95% CI： 0.62-1.00; P = 0.05], bleeding-related mortality （RR, 0.76; 95% CI： 0.31-1.42;P = 0.40）, overall mortality （RR, 0.81; 95% CI：0.61-1.08; P = 0.15） and complications （RR, 1.26;95% CI： 0.93-1.70; P = 0.13）.CONCLUSION：In the prevention of esophagealvariceal rebleeding, BB ＋ ISMN are as effective as EBL.There are few complications with the two treatment modalities. Both BB ＋ ISMN and EBL would be considered as the first-line therapy in the prevention of esophageal variceal rebleeding.     

Risk factors for predicting early variceal rebleeding after endoscopic variceal ligation

AIM: To analyze the clinical risk factors for early variceal rebleeding after endoscopic variceal ligation (EVL).METHODS: 342 cirrhotic patients with esophageal varices who received elective EVL to prevent bleeding or rebleeding at our endoscopy center between January 2005 and July 2010.were included in this study.The early rebleeding cases after EVL were confirmed by clinical signs or endoscopy.A case-control study was performed comparing the patients presenting with early rebleeding with those without thi...     

Clinical evaluation of endoscopic injection sclerotherapy using n-butyl-2-cyanoacrylate for gastric variceal bleeding

BACKGROUND: Emergency endoscopic injection sclerotherapy (EIS) has been applied to the initial treatment of gastric variceal bleeding and various methods have been attempted. METHODS: Emergency EIS was performed on 38 patients with gastric variceal bleeding using either the ethanolamine oleate (EO) method or n-butyl-2-cyanoacrylate (Histoacryl) method and the outcome was compared. RESULTS: Complete haemostasis was defined as continuous haemostasis lasting for 14 days or more. Complete haemostasis was achieved in 52.4% of patients in the EO method versus 100% of those treated with the Histoacryl method, a significant difference, suggesting that the Histoacryl method was superior for achieving haemostasis in an emergency. The cumulative non-bleeding rate was also significantly higher in patients treated with Histoacryl, indicating the durability of haemostasis.There were no serious complications in patients who received either method of sclerotherapy. Post-EIS surgery was required in 42.8% of patients treated with EO, while no surgery was required in those treated with Histoacryl, supporting the greater haemostatic effect of Histoacryl. Although there was no significant difference in the cumulative survival rates of patients treated by these two methods, death from haemorrhage was avoided by using Histoacryl. CONCLUSIONS: Based on these results, the Histoacryl method is thought to be the initial treatment of choice for gastric variceal bleeding, because it achieved superior haemostasis compared with EO and death by haemorrhage was avoided.     

内镜下套扎术治疗肝硬化食管曲张静脉破裂出血的效果分析

目的探讨内镜下套扎治疗肝硬化食管静脉曲张疗效的影响因素。方法肝硬化食管静脉曲张患者165例行内镜下食管曲张静脉套扎术(EVL)治疗,分析肝硬化者113例与肝硬化断流术后者52例行EVL术后近期及远期疗效,并观察各种相关因素对EVL疗效的影响。结果EVL治疗后EV总消失率为88.48%,EV复发率27.27%。肝硬化断流手术组与肝硬化组比较,EV复发率低,差异有显著性意义(P<0.05);EVL术前肝功能状态越差,EV和EVB再发生率越高(P<0.01),生存率越低(P<0.05);EV复发组门静脉内径和脾静脉内径较非复发组宽,有显著性差异(P<0.01);EVL术后服用哌唑嗪可降低门静脉内径、减少EV复发(18.07%)、EVB再发率(15.66%),提高生存率(85.54%,P<0.01)。结论EVL是治疗EVB安全有效的方法,近期及远期疗效确切,EVL术后服用哌唑嗪可降低门静脉压力、减少EV复发和EVB再发生率。     

Endoscopic variceal ligation is a sufficient procedure for the treatment of oesophageal varices in patients with hepatitis C liver cirrhosis: comparison with injection sclerotherapy

AIMS: Endoscopic variceal ligation (EVL) is a recently developed alternative to endoscopic injection sclerotherapy (EIS) for the treatment of oesophageal varices. Endoscopic variceal ligation and EIS were compared in an attempt to clarify the efficacy and safety of EVL for patients with cirrhosis due to hepatitis C. METHODS: Endoscopic variceal ligation was performed in 60 patients and EIS in 30. Varices were eradicated in all patients by EVL and 87% (26 out of 30) by EIS. RESULTS: There was no significant difference between EVL and EIS in relation to the incidence of bleeding and the 5 year survival rate after treatment. There were no severe complications except mild substernal pain after EVL, while pulmonary embolism occurred in one patient receiving EIS. CONCLUSIONS: Endoscopic variceal ligation is a safe and effective technique for eradicating oesophageal varices in patients with hepatitis C cirrhosis.     

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。     

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。