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。

The efficacy of reinforcing sclerotherapy after esophageal variceal ligation on recurrence of varix in patients with liver cirrhosis

Objective To evaluate the efficacy of sclerotherapy as a reinforcing method for preventing recurrence of varix after variceal eradication achieved by esophageal variceal ligation therapy. Methods Dense ligation was used to treat the esophageal varices. For the patients whose varices were eradicated or nearly eradicated,endoscopic sclerotherapy was performed. 5% ethanolamine oleate was injected into the residual varices,perivarices and submucosa at a level just above the gastro-esophageal junction. 1 to 2ml of 5% ethanolamine oleate was injected per point,and total volume was 10 to 14ml per session. Additional injection was done every 10 to 14 days if necessary. Results 49 patients in sclerotherapy-enforcing group underwent 132 sessions of injections （mean 2.7 for each patients）. During 12 to 25 months （mean 19 months） following up period,40 patients were observed no recurrent varix and the risidual varices diminished or completely eradicated. However,9 patients （18.1%） receiving variceal ligation only developed solitary varices or stripe varices accomplished with red sign. The frequency of rebleeding had significant difference （10.2% vs. 23.4%,P〈0.05） between sclerotherapy-enforcing group and EVL-alone group;the frequency of EV detected by endoscopic uhrosonography was higher in sclerotherapy-enforeing group than that of EVL-alone group（42.9% vs. 76.6%,P〈0.05）,while the frequency of perforating veins detected by endoscopic uhrosonography had no significant difference between the two groups（42.8% vs. 57.4%,P〉0.05）. Conclusion The combination of variceal obligation with subsequent endoscopic sclerotherapy is able to decrease the frequency of varices reoccurrence,and rebleeding,and therefore to improve the long-term efficacy of variceal ligation.