食管曲张静脉套扎脱痂期再出血的预防

目的探求降低食管静脉曲张套扎术(EVL)后脱痂期再出血发生率的方法。方法采用回顾性分组法,对1628例食管静脉曲张破裂出血行内镜下套扎治疗的患者分成五项严格要求组(简称:I组,1382例)与无五项严格要求组(简称:Ⅱ组,246例)。观察两组EVL术后脱痂期再出血的发生率。结果I组有6例(0．4％)脱痂期发生出血,因粗糙食物所致出血占66．7％(4／6),便秘和剧烈活动所致出血各占16．7％(1／6),病死3例(50．0％);Ⅱ组有36例(14．6％)脱痂期出血,因粗糙食物及药片所致出血占86．2％(31／36),便秘及剧烈活动所致出血符占5．6％(2／36),反酸所致2．8％(1／36),病死21例(58．3％)。两组相比EVL脱痂期再出血发生率有非常显著性差异(P<0．01);两组再出血病死率无硅著性差异(P>0．05);两组肝功能Child-Pugh C级再出血率均高于A、B级(P<0．05)。结论EVL的治疗术前严格掌握适应证,术后严格饮食卫生起居等项监督要求可以减少或避免EVL术后脱痂期的再出血的发生。

Prophylaxis of rebleeding in decrustation period after esophageal variceal ligation

Objective To probe the methods to reduce recurrence rate of haemorrhage in decruslation period after esophageal variceal ligation. Methods 1 628 cases with esophageal varix bleeding were retrospectively divided into 2 groups:group I consisted of 1 382 patients whose activity were under strict supervision, and group II consisted of 246 patients, no special requirements being ordered. Results In group I , haemorrhage occurred in 6 cases(0.4%) during decrustation period with 4 cases(66.7%) resulting from coarse food taking and 2 cases(16.7%) from constipation and vigorous activity, respectively, 3 cases died from haemorrhage. In group II , haemorrhage occurred in 36 cases (86.2%), with 2 cases resulting from coarse food or tablet taking (5.6%), 1 case from acid reflux (2.8%) and 4 cases from constipation and vigorous activity, respectively. The total death rate was 21 (58.3%). Compared with in group II,while mortality rate in group I was the same, the recurrence rate was very significantly lower(P<0.01). At last, the rebleeding rates in patients with liver function of Child-Pugh C grade were significantly higher than patients with liver function of Child-Pugh A or B grade.Conclusion Indications for esophageal varix ligation therapy and stringent adherence to regime stipulated for recovery could play a critical role in preventing recurrence of haemorrhage.