食管曲张静脉四种治疗效果的观察

本文对６２８例肝硬化食管曲张静脉破裂出血或非出血者采用５％鱼肝油酸钠＋９９．５％酒精混合剂＋口服汉防己甲素治疗并经１～９年随访。结果混合栓塞剂及加服汉防已甲素组急症止血率与单纯硬化剂组相比无统计学意义（Ｐ＞０．０５），但曲张静脉闭塞率高，再出血发生率及死亡率均比较低，与单种硬化剂组均有显著差异（Ｐ＜０．０５），副反应少。     

小剂量硬化剂加固对食管静脉曲张术后的影响

目的探讨在密集套扎疗法的基础上进行硬化加固治疗对于食管静脉曲张复发的防治作用。方法对食管静脉曲张套扎治疗后食管曲张静脉消失或基本消失的患者进行硬化剂加固治疗,从齿状线开始依次向上在残存小曲张静脉内与血管旁粘膜下层注射5％鱼肝油酸钠,每点注射1—2ml,每次共注射10—14ml。观察其对静脉曲张消失后复发的预防作用。结果加固治疗组49例共行硬化治疗132次,平均2．7次,最多治疗4次。随访12～25个月,平均18个月。结果40例（81．9％）患者未发现食管静脉曲张再出现,原有细小静脉明显减轻或消失,9例复发。加固组与单纯套扎组再出血率有明显差异（10．2％对23．4％,P〈0．05）;超声内镜检查显示加固治疗组食管曲张静脉发现率明显低于单纯套扎组（42．9％对76．6％,P〈0．01）;加固治疗组与单纯套扎组穿通支血管检出率无明显差异（42．8％对57．4％,P〉0．05）。治疗后未发现严重并发症。结论套扎治疗后小剂量硬化剂加固治疗可显著减少套扎术后残留的食管曲张静脉、防止闭塞消失的静脉再通、预防再出血,有助于提高结扎术的长期疗效,延缓静脉曲张的复发。     

双气囊压迫硬化剂治疗食管静脉曲张急性的出血

介绍双气囊压迫硬化剂注射治疗食管静脉曲张急性出血的方法，其优点主要在于通过双气囊的压迫使曲张的食管静脉血流暂时阻断，使其出血减慢或暂时停止。并在静脉内注入多量的硬化剂，不随血流稀释流失，以便在短期内发生血凝块栓塞，达到即时止血的目的。作者采用此法治疗３８例，其控制急性出血率达９７．４％。经１－４年随访，曲张静脉的消失率与硬化治疗的次数有关。本组经６次治疗后其消失率６８．７％，无严重并发症，值得推广     

双气囊压迫硬化剂治疗食管静脉曲张急性出血

介绍双气囊压迫硬化剂注射治疗食管静脉曲张急性出血的方法，其优点主要在于通过双气囊的压迫使曲张的食管静脉血流暂时阻断，使其出血减慢或暂时停止。并在静脉内注入多量的硬化剂，不随血流稀释流失，以便在短期内发生血凝块栓塞，达到即时止血的目的。作者采用此法治疗３８例，其控制急性出血率达９７．４％。经１～４年随访，曲张静脉的消失率与硬化治疗的次数有关。本组经６次治疗后其消失率为６８．７％，无严重并发症，值得推广应用。     

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。     

食管静脉曲张破裂出血内镜下介入治疗

目的总结３６４例肝炎后肝硬化合并食管静脉曲张破裂出血患者进行内镜下介入疗法的经验。方法内镜下采用５％鱼肝油酸钠（ＳＭ）或１％乙氧硬化醇（ＡＳ）进行食管静脉曲张硬化治疗（ＥＶＳ），六连发圈套器结扎治疗（ＥＶＬ）和医ＭＴＨ胶或凝血酶食管静脉内栓塞治疗（ＥＶＥ）。结果三种介入方法平均急诊止血率为８９．９％；食管静脉消失率为７７．２％。结论内镜下介入疗法是控制食管静脉曲张出血，消除食管静脉曲张的有效方法，操作较容易，再出血率较低；ＥＶＬ可替代ＥＶＳ作为食管静脉曲张破裂出血首选方法。ＥＶＥ法有异位栓塞之虑，目前暂不宜广泛开展。     

食管静脉曲张破裂出血患者四种治疗方法比较

目的 评估套扎术(EVL)、硬化剂(ES)治疗、药物治疗食管静脉破裂出血的临床疗效。方法 回顾性分析190例食管静脉曲张破裂出血患者的曲张静脉消失率、止血成功率、再出血率、病死率。结果 药物组75例，垂体后叶素组35例，3天止血成功率63．3％，再出血率60％、病死率36．7％。善宁组40例，3天止血成功率78％，再出血率59％，病死率22％。硬化剂治疗组40例止血成功率80％、再出血率32．5％、死亡率12．5％。EVL治疗组90例止血成功率95．6％、再出血率17．8％、病死率6．67％。结论 垂体后叶素、善宁在控制急性出血方面有效，但短期再出血率高；硬化剂近期疗效好，止血成功率高，曲张静脉消失率较高；EVL治疗组食管静脉根除率高，短期再出血率低，可作为食管静脉破裂出血的首选方法。     

食管静脉曲张破裂出血硬化治疗的护理

目的：探讨食管静脉曲张破裂出血硬化治疗护理的最佳方法。方法：向曲张食管静脉内直接注射5％鱼肝油酸钠，每条1．5ml；或1％乙氧硬化醇，每根静脉注射5～8ml；每次选择5～8根静脉为注射点，2周注射1次，2～3次为1疗程，3～6个月巩固治疗1次。结果：应用内窥镜结合硬化剂治疗食管静脉曲张破裂出血患者48例，除1例并发溃疡再出血转外科手术治疗外，其他全部均止血后痊愈出院，急诊止血率98％，取得了满意的疗效。     

硬化剂注射联合治疗法治疗食管静脉曲张出血

目的 观察以硬化剂注射为主联合治疗法治疗食管静脉曲张破裂出血的疗效。方法 急诊止血3例、54例先药物止血、7例药物止血失败后用三腔双囊管压迫止血。待病情稳定后再施硬化治疗术。硬化剂用5％鱼肝油酸钠，术后降门脉压、倒酸、抗感染治疗。结果 急诊止血率100％，半年近期复发率为10．9％，1年生存率为89．06％，2年生存率为79．68％。结论 联合治疗法是目前治疗食管静脉曲张破裂出血行之有效的方法之一。     

大剂量鱼肝油酸钠合用立止血治疗食管静脉曲张破裂出血的临床研究

采用大剂量鱼肝油酸钠行食管曲张静脉内注射治疗大出血，疗效确定，但拔地后注射部位的出血不可避免。为防止或减少出血，我院采用先注射鱼肝油酸钠，停针２－３分钟再注射立止血。并同时退针的方法。共治疗４０例，８２例次。止血效果好，同时发现注射部位溃疡发生率低，复发出血率低，曲张静脉消失率高。因此，大剂量鱼肝油酸钠合用立止血是一种有效的治疗方法。     

食管静脉曲张破裂大出血的急诊硬化治疗

目的 总结食管静脉曲张破裂大出血极危重患者在急诊内镜下行硬化治疗(EIS)的经验。方法 176例食管静脉曲张破裂大出血患者在改良三腔管牵引下，共用5%鱼肝油酸钠食管静脉内注射209次，其中181次为致死性活动性大出血。结果 首次EIS能明确出血部位166例(94．3%)，急诊EIS止血成功201次(96．2％)，其中21例为多次EIS后止血，并发症15例(8．5％)，死亡3例(1．7％)。结论 改良三腔管牵引下行EIS是急诊救治致死性食管静脉曲张大出血的安全、有效、简便方法。     

Comparative effects of 5% ethanolamine oleate versus 5% sodium morrhuate for sclerotherapy of oesphageal varices

Forty-five cirrhotic patients with oesophageal varices were randomized to receive endoscopic injection sclerotherapy with either 5% ethanolamine oleate (EO), or 5% sodium morrhuate (SM). In the EO group, there was a statistically significant higher rate of disappearance of red colour signs on the varices a week after the initial session of sclerotherapy than in the SM group (91.3% vs 45.5%, P less than 0.05). A jet-like bleeding from injection sites at the second session of sclerotherapy occurred in three patients in the SM group and they experienced blurred vision. There was no such occurrence in the EO group. Oesophageal bleeding requiring blood transfusion during the course of repeated sclerotherapy occurred only in the SM group (five patients): bleeding was from a partly thrombosed varix and in four was from oesophageal ulcers. We found that EO administered intravariceally is more efficacious than SM for sclerotherapy of oesophageal varices.     

Endoscopic management for bleeding esophageal varices: sclerotherapy versus sclerotherapy plus band ligation versus band ligation alone. One year experience at a main hospital in Saudi Arabia.

BACKGROUND/AIMS: This study was done retrospectively to compare the outcome of sclerotherapy alone, band ligation alone and band ligation alternating with sclerotherapy in treatment of esophageal varices. METHODOLOGY: During 1 year 30 patients were admitted with variceal bleeding. They received either injection sclerotherapy (8 patients) or band ligation (11 patients), and 11 patients had a combination of both either during first bleed or during follow-up therapy, which is more than 2 sessions in each group. RESULTS: The success rate for stopping first bleeding was 100% in the band ligation and sclerotherapy alone group. The rebleeding rate was 27% in the combination group, 9% in the band ligation group, and none had rebleeding in the sclerotherapy group during follow-up. Eradication of varices was observed in 33% of patients after a second set of sclerotherapy and band ligation. CONCLUSIONS: Our study showed no significant difference between sclerotherapy versus band ligation in stopping initial bleeding or eradication of varices during the follow-up period, but there was a difference in re-bleeding rates among the three groups.     

Squamous Cell Carcinoma after Endoscopic Injection Sclerotherapy for Esophageal Varices

We report two cases of squamous cell carcinoma of the esophagus following endoscopic injection sclerotherapy for esophageal varices. The interval between sclerotherapy and the development of carcinoma was 24 months in case 1 and 21 months in case 2. The sclerosant was 5% sodium morrhuate in case 1 (total dose, 10 ml) and 5% ethanolamine oleate in case 2 (45.5 ml). Although no recurrent variceal bleeding occurred after sclerotherapy, we could not perform any curative surgical treatment for esophageal cancer because of the advanced stage of the cancer and the severity of the accompanying liver dysfunction. It is difficult to determine the relationship between sclerotherapy and carcinoma; however, long-term surveillance is essential to avoid overlooking a neoplasm in the esophagus after endoscopic injection sclerotherapy.     

胃镜下聚桂醇注射治疗肝硬化并发食管静脉曲张患者临床疗效研究

目的 探讨在胃内镜下聚桂醇注射治疗肝硬化并发食管静脉曲张患者的临床疗效及安全性。方法 2016年1月~2017年12月在我院行内镜下硬化治疗的肝硬化并发食管静脉曲张患者80例,其中38例接受内镜下注射聚桂醇治疗,另42例接受内镜下注射鱼肝油酸钠治疗,随访12个月。结果 注射聚桂醇组显效和有效率分别为65.8%和26.3%,与注射鱼肝油酸钠组的69.0%和26.2%比,差异无统计学意义（P>0.05）;注射聚桂醇组急诊止血成功率和再出血发生率分别为92.1%和34.2%,与注射鱼肝油酸钠组的95.2%和31.0%比,差异均无统计学意义（P>0.05）;注射聚桂醇组术后发热、胸痛、溃疡和食管狭窄发生率分别为13.2%、13.2%、10.5%和2.6%,均明显低于注射鱼肝油酸钠组（分别为33.3%、38.1%、42.9%和19.1%,P<0.05）;在随访3个月、6个月和12个月时,注射聚桂醇组曲张静脉复发率分别为10.53%、18.42%和28.95%,与注射鱼肝油酸钠组的9.52%、14.29%和30.95%比差异无统计学意义（P>0.05）。结论 在胃内镜下注射聚桂醇治疗肝硬化并发食管静脉曲张患者止血成功率高,疗效确切,且术后并发症发生率较低,是一种安全有效的治疗方法。     

Venography during endoscopic injection sclerotherapy of esophageal varices

Utilizing an equal mixture of 5% sodium morrhuate and 60% renografin, we studied four patients during a total of nine sessions of injection sclerotherapy of esophageal varices to determine radiographically the fate of injected sclerosant. Despite attempted intravariceal injections, 44% resulted in local and presumably paravariceal accumulation of contrast material within the esophageal wall. During 42% of injections, contrast material was rapidly cleared in a cephalad direction and proximal balloon compression of the esophagus did not prevent cephalad flow of sclerosant. In 14% the injected material was rapidly cleared in a caudal direction toward the gastric veins. This technique may be useful in future evaluations of the efficacy of various methods of injection sclerotherapy of esophageal varices.     

Effect of endoscopic variceal sclerotherapy on gas exchange and hemodynamics in humans

Adult respiratory distress syndrome has been reported after endoscopic variceal sclerotherapy with sodium morrhuate. It has been proposed that sclerosant entering the pulmonary circulation during intravariceal injections may cause pulmonary hypertension and capillary injury. The purpose of this study was to determine whether variceal sclerotherapy with sodium morrhuate causes capillary injury or pulmonary edema in humans. We studied the effect of sclerotherapy on gas exchange and pulmonary and systemic hemodynamics in 8 patients who required endoscopic variceal sclerotherapy for treatment of variceal hemorrhage. The pulmonary vascular resistance index increased from 246 +/- 67 dyn X s X cm-5/m2 (mean +/- SEM) at baseline to a high of 303 +/- 85 dyn X s X cm-5/m2 60 min after sclerotherapy (normal range 250-500 dyn X s X cm-5/m2). Pulmonary artery pressure remained stable while cardiac index decreased by 12% over the same period. There were also small increases in systemic vascular resistance index and systemic arterial pressure after sclerotherapy. Although there was no change in arterial oxygen tension, the alveolar-arterial oxygen difference improved after sclerotherapy. These results indicate that variceal sclerotherapy with sodium morrhuate is associated with clinically insignificant changes in pulmonary and systemic hemodynamics. We did not detect evidence of acute lung injury after sclerotherapy.     

The treatment of gastric fundal varices--endoscopic therapy versus interventional radiology

BACKGROUND/AIMS: Balloon-occluded retrograde transvenous obliteration is an effective method for treating gastric fundal varices. The present retrospective study was performed to determine the clinical efficacy for gastric fundal varices associated with endoscopic therapy, surgery, and interventional radiology including balloon-occluded retrograde transvenous obliteration. METHODOLOGY: We classified 26 patients to a surgery group, an endoscopic therapy group, and an interventional radiology group according to initial treatment and subsequent treatment, and we compared the rates of hemostasis, eradication, and bleeding in these groups. RESULTS: Interventional radiology was successful in arresting acute hemorrhage in 100% of cases, while endoscopic therapy was successful in only 50% of cases. The rate of eradication was 100% in the Surgery group, 66.7% in the Endoscopic Therapy group, and 50% in the Interventional Radiology group. The cumulative bleeding rate at 5 years was 0% in the Surgery group, 0% in the Endoscopic therapy group, and 11.1% in the Interventional Radiology group. No significant difference was observed between the three groups. CONCLUSIONS: The treatment-of-choice for gastric fundal variceal hemorrhage is endoscopic injection sclerotherapy and ligation, with interventional radiology as the back-up procedure in case endoscopic injection sclerotherapy and ligation is unsuccessful. Interventional radiology is the treatment-of-choice for elective treatment of gastric fundal varices.     

Efficacy of absolute alcohol injection compared with band ligation in the eradication of esophageal varices

BACKGROUND: Endoscopic sclerotherapy is an absolute indication for treating esophageal varices. Re-bleeding is common during the treatment period, before all varices become eradicated. AIM: To compare two techniques of endoscopic esophageal varices eradication: sclerotherapy with absolute alcohol and banding ligation. PATIENTS AND METHOD: Forty-six patients with liver cirrhosis and esophageal varices were prospectively randomized into two treatment groups: endoscopic sclerotherapy with absolute alcohol and banding ligation. Patients were included if they had large varices with signs of high bleeding risk. Informed writing consent was obtained from every patient and the Ethics Committee of Federal University of S?o Paulo, SP, Brazil, approved the study. After eradication, all patients were followed up to 1 year to look for re-bleeding episodes and variceal recurrence. RESULTS: Both groups were similar except that male gender was more common in the sclerotherapy group. There was no statistical difference regarding variceal eradication (78.3% in sclerotherapy group vs 73.9% in the ligation group), recurrence (26.7% vs 42.9%, respectively) and death related to any cause (21.7% vs 13.9%). In the sclerotherapy group more sessions were need to obtain complete variceal eradication. In this group we did observe a high re-bleeding rate (34.8%) and more ulcers associated with retrosternal pain right after the procedure. There was no difference regarding overall morbidity and mortality. CONCLUSIONS: Banding ligation requires fewer sessions than sclerotherapy with absolute alcohol to eradicate esophageal varices. Both methods are equally efficient regarding variceal eradication and recurrence during a short follow-up period.