内镜结扎术治疗食管静脉曲张急性出血

采用内镜结扎术(EVL)治疗食管静脉曲张急性出血78例。首次EVL的实施距出血发作时间:8h以内10例,9～48h 26例,49～72h 37例,超过72h 5例。急性出血被控制后,每隔2周重复EVL直至静脉曲张被根除或缩小至Ⅰ°以下。经该法治疗,近期止血率达93.6％;63例生存病人经平均4次(2～7次)EVL,55例(87％)食管静脉曲张被根除或缩小至Ⅰ°以下;未发现与EVL有关的严重并发症。平均随访25月(8～48月),有11例病人复发出血(17％),这些再出血大多发生在曲张静脉根除之前,且容易被重复EVL控制出血。该组结果显示:EVL止血效果确切,安全易行,并发症少;对食管静脉曲张急性出血,尤其伴有肝功能不良者,EVL可作为首选的有效治疗方法。

ENDOSCOPIC LIGATION FOR ACUTE ESOPHAGEAL VARICEAL BLEEDING

The purpose of this study was to evaluate the efficacy and safety of EVL as a treatment of active variceal bleeding. EVL was used to treat 78 patients with actively bleeding esophageal varices. Following the initial control of bleeding, EVL was repeated at two week intervals until varices were eradicated or reduced to grade I or less. Active bleeding was controlled in 73 of the 78 patients (93. 6% ). Variceal eradication or reduction to grade I or less was achieved in 55 of the 63 surviving patients, with a mean of four repeat EVL sessions (range 2~7). No major EVL - related complications were observed. Recurrent bleeding during a mean follow up period of 25 months (range 8~ 48) occurred in 11 of the 63 surviving patients. Prior to variceal eradication, all but one of the patients experienced rebleeding which was easily treated with repeated EVL. These results show that EVL is a safe, effective and rather simple method which should be considered the primary method with which to treat actively bleeding esophageal varices, especially in patients with poor liver function.