经皮经肝组织胶栓塞治疗食管静脉曲张与内镜下套扎治疗的疗效比较

目的比较经皮经肝α氰基丙烯酸正辛酯（TH胶）栓塞术（PTVE）与内镜下食管静脉套扎术（EVL）治疗食管静脉曲张的临床疗效。方法急性及近期食管胃静脉曲张出血的肝硬化患者随机分成PTVE组（52例）及EVL组（50例）进行干预治疗，观察术后上消化道再出血率、食管曲张静脉复发率及生存率。结果随访期间（PTVE组平均24个月，EVL组25个月）两组的上消化道再出血率分别为15．4％（8／52）和42％（21／50）（χ^2=8．87，P=0．005），其中食管曲张静脉再出血率为5．8％（3／52）和24％（12／50）（χ^2=5．38，P=0．012），两组食管静脉曲张复发率分别为17．3％（19／52）和52％（26／50）（χ^2=13．61，P〈0．001），两组生存率相似，（χ^2=3．30，P=0．054）。结论PTVE能使曲张静脉及其穿支静脉和贲门胃底静脉周围静脉一并栓塞，术后食管静脉曲张的再出血率低于EVL治疗，具有较好临床价值。

Percutaneous transhepatic variceal embolization with cyanoacrylate versus endoscopic ligation in management of esophageal variceal bleeding

Objective To compare the therapeutic effect of percutaneous transhepatic variceal em-bolization (PTVE) with Cyanoacrylate(TH glue) with that of endoscopic variceal ligatien (EVL) in the treatment of esophageal varlceal bleeding. Methods In this prospective randomized controlled trial, cirrhot-ic patients with acute or recent esophageal variceal bleeding were assigned randomly to PTVE (n = 52) or EVL (n=50) groups. Variants including upper gastrointestinal (UGI) re-bleeding, esophageal variceal re-bleeding, relapse of esophageal variees and survival were evaluated. Results During the follow-up (median 24 and 25 months in the PTVE and EVL groups, respectively), UGI re-bleeding developed in 8 patients (15. 4%) in PTVE group and in 21 (42%) in EVL group (X2 =8. 87, P=0. 005). Recurrent esophageal varices bleeding occurred in 3 patients (5. 8%) in FIVE group and 12 (24%) in EVL group (X2 =5.38, P =0. 012, relative risk 0. 24, 95% confidence interval 0. 05 -0. 74). Reccurent rates of esophageal vari-ces in two groups were 17.3% (9/52) and 52% (26/50), respectively (X2 =13.61, P<0.001). There was no significant difference in survival rate between two groups (X2 = 3.30, P = 0. 054). Conclusion With sufficient embolization of lower esophageal and pefi-esophngeal varices and/or the cardial submucosal and perforating vessels, PTVE was more effective than EVL in the management of esophageal varices recur-rence and re-bleeding.