食管静脉曲张密集结扎术和硬化及结扎联合术的疗效对照观察

比较内镜下食管静脉曲张密集结扎术和内镜下硬化及结扎联合术治疗食管静脉曲张破裂出血的疗效。４２例食管静脉曲张破裂出血病情稳定的病人分为两组，２２例患者接受ＤＥＶＬ，２０例病人行ＥＳ＋ＥＶＬ，两组具有可比性（Ｐ＞０．０５）。第１次治疗，ＤＥＶＬ组每个病人平均结扎１１．３２个点，每根曲张静脉平均结扎２．８３个点；ＥＳ＋ＥＶＬ组首先静脉内注射硬化剂，然后行结扎，第１次治疗平均每根曲张静脉注射硬化剂１．０３次（点），结扎１．０１个点。结果：第１次治疗后，ＤＥＶＬ组食管静脉曲张消失率为５０％，ＥＳ＋ＥＶＬ组为３５％，两组比较无统计学意义（Ｐ＞０．０５）；第１、４、１２及２４周的再出血率，ＤＥＶＬ组为４．５％、４．５％、４．５％、４．５％，ＥＳ＋ＥＶＬ组为１０％、１５％、１５％、２５％，两组无显著差别（Ｐ＞０．０５）。ＤＥＶＬ和ＥＳ＋ＥＶＬ均为治疗食管静脉曲张破裂出血、根除食管静脉曲张的有效方法，ＤＥＶＬ的操作较容易、并发症较少、再出血率较低，内镜下食管静脉曲张密集结扎术将取代内镜下硬化剂注射疗法，成为治疗食管静脉曲张破裂出血的首选方法。     

食管静脉曲张硬化栓塞疗法并发症及其防治

食管静脉曲张硬化栓塞疗法并发症及其防治李增烈食管静脉曲张硬化栓塞疗法（ＥＶＳ）经历了曲折的发展过程和考验，其疗效已被公认，并作为食管静脉曲张破裂出血的首选疗法，挽救和延长了许多患者的生命；但ＥＶＳ毕竟是一种创伤性治疗，且在肝功能不全的背景下进行，常常...     

经内镜结扎并硬化治疗食管静脉曲张出血

经内镜结扎并硬化治疗食管静脉曲张出血朱春兰田素礼孙秀芝朱雅琪我们经内镜食管静脉曲张结扎术（ＥＶＬ）使粗大的食管静脉（ＥＶ）血栓形成以后，采取自由法行食管静脉曲张注射硬化疗法（ＥＩＳ），不仅减少了ＥＶＬ操作次数，又明显的减少了ＥＩＳ的合并症，而且所用硬...     

经内镜结扎及硬化联合治疗食管静脉曲张出血的探讨

食管静脉曲张破裂出血是肝硬化门静脉高压症常见的并发症,内镜食管静脉硬化（ＥＶＳ）和内镜食管静脉结扎术（ＥＶＬ）治疗食管静脉曲张出血（ＥＶＢ）,国内外已公认其止血效果,并列为首选治疗方法,但各有优缺点［１］。单纯多次ＥＶＳ治疗具有局部和全身并发症,止血...     

内镜下套扎术和硬化术治疗食管静脉曲张出血的疗效比较

内镜下套扎术和硬化术治疗食管静脉曲张出血的疗效比较山东省滕州市中心人民医院（２７７５００）庞德水武宗义陈秀芹１９９４年５月至１９９７年４月，我们采用内镜下食管静脉曲张套扎术（ＥＶＬ）和食管静脉曲张硬化术（ＥＶＳ）共治疗食管静脉曲张出血患者６９例，取得...     

门脉高压食管静脉曲张出血介入治疗

目的评估ＥＶＳ、ＥＶＬ、组织粘合剂注射及ＴＩＰＳＳ治疗门静脉高压食管胃静脉曲张出血的优缺点。方法对７１２例食管胃静脉曲张出血病人进行了回顾分析。结果ＥＶＳ６１５例，经１８２６次治疗，急诊止血率为９６．９％，食管静脉曲张消失率为８４．６％，并发症发生率为１４．７％，肝硬化患者３４４人随访１２～１０４月，１、３、５年生存率为９１．５２％±１．３６％．７１．４２％２１．７１、４７．１３％±１．８６％。ＥＶＬ３０例，食管静脉消失率为７６．７％，复发出血１３．３％。组织粘合剂注射１２例，急诊６例全部止血。ＴＩＰＳＳ治疗先例。成功率为９０．９％食管静脉曲张消失和好转为８２．３％并发症发生率为３６％。一年内支架闭塞、狭窄、复发出血１６例（３８．０９％），随访１２～４２月，死亡１２人（２１．８％）。结论内镜下介入治疗是食管静脉曲张出血首选方法。急诊止血以ＥＶＳ和内镜下组织粘合剂注射为优，ＥＶＬ浸润性并发症低，但反复出血率较高，ＴＩＰＳＳ治疗中远期疗效不佳。     

内镜下食管静脉曲张硬化疗法22例报告

内镜下食管静脉曲张硬化疗法２２例报告李敏，张国旺内镜下食管静脉曲张硬化疗法（ＳｃｌｅｒｏｔｈｅｒａｐｙｆｏｒＥｓｏｐｈａｇｅａｌＶａｒｉｃｅｓ，ＥＶＳ）已被公认，但静脉内直接注射易发生拔针后针孔出血，甚至大量喷血，使治疗失败。作者采用三点注射滞针铺气...     

内镜下连续套扎追加硬化术治疗食管静脉曲张疗效观察

内镜下硬化术（ＥＶＳ）治疗食管静脉曲张出血存在多种并发症 ,内镜下套扎术（ＥＶＬ）具有止血率高 ,并发症少 ,操作容易方便等优点而广泛应用。我们采用连续套扎追加小剂量硬化剂注射治疗食管静脉曲张 ,并与ＥＶＬ对照观察 ,初步显示其优点 ,现总结如下 :一 ,临床资料 :选择１９９５年２月至１９９７年２月因肝硬化门脉高压并发食管静脉曲张出血病人２０例 ,内镜下食管静脉曲张均为中 -重度 ,随机分为两组 :（１）ＥＶＬ组１０例 ,男８例 ,女２例 ,平均年龄４９．７岁 ,肝功能Ｃｈｉｌｄ分级Ａ级５例、Ｂ级３例、Ｃ级２例 ;（２）ＥＶＬ …     

食管静脉曲张出血内镜下套扎与硬化治疗对照研究

肝硬化并发食管静脉曲张（ＥＶ）破裂，出血量大、死亡率高。近年内镜下套扎（ＥＶＬ）与硬化剂注射（ＥＶＳ）已成为主要治疗措施。我们自１９９４年１月至２００１年１月采用前瞻对照法对愿意参加本研究的ＥＶ出血患者进行ＥＶＬ和ＥＶＳ的疗效和安全性比较。　一、一般资料　参与研究的７４例患者，年龄３５～８５岁，均为慢性乙型肝炎后肝硬化所致的门脉高压症，并符合下列条件：急性出血表现为呕血、黑粪；急诊内镜见食管曲张静脉破裂喷血、渗血或近期出血征象（血痂或溃烂）。排除标准：胃静脉曲张、门脉高压性胃病及溃疡出血；合并胃…     

食管静脉曲张患者内镜下结扎术前后血浆内皮素、降钙素基因相关肽的变化

食管静脉曲张破裂出血是上消化道出血的常见原因之一,内镜下食管静脉曲张结扎术（ｅｎｄｏｓｃｏｐｉｃｖａｒｉｃｅａｌｌｉｇａ－ｔｉｏｎ,ＥＶＬ）是继内镜下硬化注射疗法之后的又一种新方法,且已得到广泛应用并取得了较为理想的效果［１］。我们应用放射免疫法测定ＥＶＬ前后血浆内皮素（ＥＴ）和降钙素基因相关肽（ＣＧＲＰ）的动态变化,以其探讨ＥＶＬ对全身血流动力学的影响。１．资料：１９９６年１０月～１９９７年３月住院患者１５例,经临床、Ｂ超、ＣＴ、胃镜等已确诊为肝炎后肝硬化伴重度食管静脉曲张。男１２例,女３例,…     

内镜下结扎食管静脉曲张的疗效评估:216例临床分析

作者采用内镜结扎术治疗216例食管静脉曲张病人,其中69例有急性出血,经此方法治疗后,即时止血率达92.8％。经3～5次结扎后,其中80％的食管静脉曲张消失或缩小至Ⅰ°以下。未发生与结扎术有关的严重并发症。随访4～40个月(平均16月),出血复发率为17.1％,有25例死亡。结果表明:内镜结扎术疗效好,操作方便,并发症少,可适用于肝功能差、不能耐受手术以及手术后或硬化剂治疗后食管静脉曲张复发出血的病人。     

Prospective multicenter randomized trial comparing banding ligation with sclerotherapy of esophageal varices.

BACKGROUND/AIMS: Endoscopic variceal banding ligation (EVL), first described by Stiegmann in 1988, is now an accepted alternative to sclerotherapy (EVS) for esophageal varices with previous bleeding. However, results are conflicting in terms of complications, eradication, recurrence, rebleeding and mortality rate. We aimed to compare EVL with EVS in a prospective randomized trial in patients with previous esophageal bleeding proved by endoscopy. End points were rebleeding rate and death during a short (eradication period) or long-term follow-up (> 1 year). METHODOLOGY: One hundred patients (50 EVL, 50 EVS) were enrolled. Eradication rate, number of treatments needed to achieve eradication, recurrence of varices, rebleeding and complications were recorded and analyzed. RESULTS: No differences were observed between the two groups regarding age, sex and Child class. One patient dropped out in the EVL group and 6 in the EVS group. Eradication was obtained in 44 (88%) with EVL and 41 (82%) with EVS with a mean of 3.41 and 5.29 treatments (p<0.001), respectively. Rebleeding occurred during eradication in 6 patients (12%) in the EVL group and 21 (42%) in the EVS group (p=0.001); after eradication, 7 patients (14%) rebled in the EVL group and 4 (8%) in the EVS group (not significant). Non-variceal bleeding was observed in 5 patients (2 EVL and 3 EVS) during follow-up. Two patients in the EVL group died after variceal rebleeding; 3 died of gastric bleeding; and, 15 from non-hemorrhagic events (8 EVL and 7 EVS). In the EVL group 14 patients had recurrent varices and 7 rebled; in the EVS group 11 recurred, with rebleeding in 5. Major complications were fewer in the EVL group (1 stenosis, 4 chronic ulcers) compared to 18 patients in the EVS group (9 stenosis and 9 chronic ulcers) (p<0.005). CONCLUSIONS: EVL might be preferable to EVS for faster reduction and obliteration of varices, with a lower rate of complications and rebleeding before eradication. No differences were observed in recurrence.     

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。     

急诊内镜下套扎与硬化治疗食管静脉曲张破裂出血的比较

目的比较食管静脉曲张破裂出血急诊内镜下套扎与硬化治疗的疗效和安全性。方法对210例食管静脉曲张破裂出血患者,急诊情况下行内镜下套扎或硬化治疗,并分析比较两组急诊止血成功率、近期再出血率、急诊治疗曲张静脉消失率、不良反应、并发症、病死率等情况。结果急诊止血成功率套扎组达95.4%,硬化组达96.0%;近期再出血率分别为4.8%和4.1%;套扎组急诊治疗曲张静脉消失率明显优于硬化组（P〈0.01）。两组不良反应、并发症及病死率无差别。临床疗效与肝功能呈正相关。结论急诊内镜下套扎与硬化治疗食管静脉曲张出血均为有效、安全的止血方法。临床上可结合患者实际情况综合考虑后选择。     

经内镜结扎和硬化剂治疗食管静脉曲张和门脉高压性胃病的疗效及预后

目的：观察经内镜结扎和硬化剂治疗食管静脉曲张的疗效及对门脉高压性胃病（PHG）的影响。方法;对92例患者随机分为套扎组（n=43)和硬化剂（n=49),分别在治疗后1－3月和1－3年内复查。观察静脉曲张及PHG的转归情况。结果：1－3月内复查套扎组完成26例,其中食管静脉曲张根除12例,曲张减轻12例,无效2例,PHG加重17例。硬化剂组完成29例,其中静脉曲张根除4例,曲张减轻22例,无效3例,PHG加重11例。1－3年内复查套扎组和硬化剂组的再曲张率及再出血率分别为61．5％、46．7％和44．4％．33．3％。结论：近期套扎治疗在根治静脉曲张方面优于硬化剂注射,但更易诱发和加重PHG。而套扎组和硬化剂组远期均可出现再曲张和再出血。两组比较无差异。     

Evaluation of endoscopic variceal ligation in prophylactic therapy for bleeding of oesophageal varices: a prospective, controlled trial compared with endoscopic injection sclerotherapy

BACKGROUND: To evaluate the efficacy of endoscopic variceal ligation (EVL) in prophylactic therapy for oesophageal varices, we performed a randomized prospective trial to compare the recurrence of oesophageal varices treated by EVL with those treated by endoscopic injection sclerotherapy. METHODS: Fifty patients with liver cirrhosis were divided into two groups at random, after informed consents were obtained, to receive prophylactic therapy for bleeding of oesophageal varices. Group 1 patients underwent sessions of sclerotherapy with 5% ethanolamine oleate used as the sclerosant. Group 2 patients underwent EVL followed by one or two sessions of sclerotherapy. RESULTS: During the 18 month follow-up period, both the recurrence rate in group 2 (56%) and the incidence of bleeding (20%) were significantly higher compared with group 1 (recurrence rate 16%, bleeding 0%). CONCLUSIONS: This result indicates that EVL is not effective for prophylactic therapy for oesophageal varices in liver cirrhosis.     

门静脉海绵样变性病因及治疗

目的 探讨门静脉海绵样变性的病因和治疗。方法 对28例门静脉海绵样变性住院患者的临床资料进行回顾性分析。结果 2B例患者中15例（占53．6％）病因比较明确，13例（占46．4％）未发现明确病因；28例患者中20例有出血史，其中15例行内镜下套扎、硬化剂或组织胶注射治疗，随访4～96月，食管胃底静脉曲张基本消失，1例因食管溃疡再发出血，1例出现食管狭窄。结论 门静脉海绵样变性的病因为多因素；对有消化道出血的患者内镜下治疗可以起到急诊止血和预防再出血的作用。     

Endoscopic variceal ligation: an alternative to sclerotherapy

Endoscopic variceal ligation (EVL) consists of mechanical ligation and thrombosis of varices using elastic "O" rings. This study assessed the efficacy and safety of EVL as definitive therapy for bleeding esophageal varices. During a 16-month period, 68 consecutive patients with bleeding varices had EVL. Fourteen patients died from 3 to 125 (median = 12.5) days after initial EVL. Fifteen (88%) of those actively bleeding at index treatment had bleeding controlled during index hospitalization. Survivors of index hospitalization had a 37% incidence of recurrent bleeding. Thirty-five patients had varices eradicated or reduced to small size with a median of five EVL treatments. No significant treatment-related nonbleeding complications resulted from 265 EVL sessions. EVL appears to control active variceal bleeding and eradicates varices with repeat treatments. EVL results in few nonbleeding complications, and may be employed as a safe alternative to sclerotherapy.     

Endoscopic variceal ligation compared with endoscopic injection sclerotherapy for treatment of esophageal variceal hemorrhage:A meta-analysis

AIM:To compare the effect of endoscopic variceal ligation(EVL)with that of endoscopic injection sclerotherapy(EIS)in the treatment of patients withesophageal variceal bleeding.METHODS:We performed a systematic literature search of multiple online electronic databases.Metaanalysis was conducted to evaluate risk ratio(RR)and95%confidence interval(CI)of combined studies for the treatment of patients with esophageal variceal bleeding between EVL and EIS.RESULTS:Fourteen studies comprising 1236 patients were included in the meta-analysis.The rebleeding rate in actively bleeding varices patients in the EVL group was significantly lower than that in the EIS group(RR=0.68,95%CI:0.57-0.81).The variceal eradication rate in actively bleeding varices patients in the EVL group was significantly higher than that in the EIS group(RR=1.06,95%CI:1.01-1.12).There was no significant difference about mortality rate between the EVL group and EIS group(RR=0.95,95%CI:0.77-1.17).The rate of complications in actively bleeding varices patients in the EVL group was significantly lower than that in the EIS group(RR=0.28,95%CI:0.13-0.58).CONCLUSION:Our meta-analysis has found that EVL is better than EIS in terms of the lower rates of rebleeding,complications,and the higher rate of variceal eradication.Therefore,EVL is the first choice for esophageal variceal bleeding.     

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.