硬化剂注射预防食管静脉曲张破裂出血远期疗效研究

目的观察肝硬化食管静脉曲张患者分别行内镜下注射硬化剂（endoscopic injection sclerotherapy,EIS）和口服卡维地洛后的再出血发生率、死亡率和治疗前后食管静脉曲张程度以及肝功能的分级变化。方法入选患者89例,其中50例患者采用EIS治疗,39例患者采用药物预防性治疗,EIS组患者给予多次注射硬化剂,直至曲张静脉消失,药物治疗组给予卡维地洛,起始剂量为6.25mg,每日2次,逐渐增加剂量至最大耐受量12.5mg,每日2次。全部患者观察36个月,对比两组间的再出血发生率和死亡率、治疗前后静脉曲张程度以及肝功能分级变化。结果 EIS治疗组有效随访44例,期间发生出血7例（15.9%）,死亡3例（6.8%）。药物治疗组有效随访34例,期间发生出血10例（29.4%）,死亡4例（11.8%）。两组间再出血发生率和死亡率差异有统计学意义（P〈0.05）。EIS治疗组静脉曲张总消失率为40.9%（18/44）,卡维地洛治疗组曲张静脉均未消失;比较两组治疗前后肝功能Child-Pugh评分未见明显差异（P〉0.05）。结论与药物卡维地洛治疗相比,EIS治疗可以降低再出血发生率、死亡率和静脉曲张程度,同时患者肝功能无明显损害。

Clinical study on long-term effect of endoscopic injection sclerotherapy to prevent esophageal variceal bleeding

Objective To investigate the esophageal variceal bleeding,mortality,degree of varices and changes of liver function in patients with hepatic cirrhosis who underwent endoscopic injection sclerotherapy （EIS） or received carvedilol therapy.Methods Eighty-nine patients received either EIS（n=50） or received carvedilol therapy （n=39）.The patients in EIS group were treated with EIS for several times until varicose vein disappeared.Meanwhile,patients in carvedilol group received 6.25mg dose of carvedilol,twice daily at the beginning of treatment,and the dose was increased to maximum tolerated dose gradually.All patients were followed up for 36 months.The bleeding rate,mortality,improvement of varicose vein and changes of liver function before and after treatment were compared between two groups.Results Among 44 patients of EIS group,bleeding occurred in 7 patients （15.9%）,3 patients （6.8%） died,in carvedilol group bleeding occurred in 10 （29.4%） of 34 patients and 4 patients （11.8%） died.The difference between EIS group and carvedilol group were significant （P0.05）.40.9% （18/44） of varicose vein vanished in EIS group,at the same time,no varicose vein disappeared in carvedilol group.The changes of hepatic function in two groups before and after treatment were of no significance（P0.05）.Conclusion Compared with carvedilol therapy,EIS can reduce bleeding and mortality as well as improving the degree of varicose vein without liver damage.