内镜套扎及组织胶栓塞治疗食管胃底静脉曲张出血的疗效观察

【摘要】目的探讨内镜下静脉曲张套扎术（EVL）及组织胶栓塞术治疗食管胃底静脉曲张出血的临床疗效。方法回顾性分析452例食管胃底静脉曲张出血患者的食管静脉曲张EVL和胃底静脉曲张组织胶栓塞术治疗及随访情况，对治疗效果及并发症进行总结。结果急诊止血成功率为100．0％（145／145），早期再出血率为1．8％（8／452），早期不良反应发生率为50．0％（226／452），并发症发生率为12．4％（56／452）。EVL治疗食管静脉曲张有效率和显效率分别为32．5％（145／446）和40．4％（180／446）；组织胶栓塞术治疗胃底静脉曲张有效率和显效率分别为32．5％（136／419）和27．4％（115／419）。426例随访9—37个月，平均18个月，再出血发生率为10．1％（43／426），6个月生存率为97．9％（417／426），1年生存率为89．9％（383／426）。结论EVL及组织胶栓塞术治疗食管胃底静脉曲张疗效较好，两者联合治疗操作简单、疗效好、患者创伤小，既可以用于急诊止血，也可用于二级预防。

The clinical efficacy of EVL and injection of tissue adhesive for esophageal and gastric varices bleed- ing

Objective To evaluate the clinical efficacy of endoscopic variceal ligation （EVL） com- bined with injection of tissue adhesive for esophageal and gastric varices bleeding. Methods Data of 452 patients with esophageal and gastric varices bleeding who received EVL and injection of tissue adhesive were retrospectively studied. Results The instant hemostatic rate was 100. 0% （ 145/145 ）. Early rebleed- ing rate was 1.8% （8/452）. Incidence of early adverse reactions was 50.0% （226/452）. The total inci- dence rate of complications was 12.4% （56/452）. Efficiency and effectiveness of EVL were 32. 5% （145/446） and 40.4%（180/446） respectively. Efficiency and effectiveness of injection of tissue adhesive were 32. 5% （136/419） and 27.4% （115/419） respectively. With an average of 18 months＇ follow-up （ ranging from 9 to 37 months）, the rate of rebleeding was 10. 1% （ 43/426）, six-month and one-year survival rate was 97. 9% （417/426） and 89. 9% （383/426） respectively. Conclusion EVL combined with injection of tissue adhesive for esophageal and gastric varices is effective, convenient, and less invasive. They can be used not only for emergency hemostasis but also for secondary prophylaxis.