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目的 观察食管静脉曲张 (EV)破裂出血内镜套扎治疗的疗效和并发症。方法 对 1998 0 7-2 0 0 1 0 4因肝硬化EV破裂出血住院的 41例患者 ,采用美国Microvasive公司 5连发套扎器行套扎治疗 ,并对其疗效和并发症进行了随访平均 ( 7.5 4± 7.47)月。结果 16例活动性出血期套扎治疗者 ,急诊止血成功率达 10 0 %。全组除 1例血止后做肝移植外 ,40例中有 34例于套扎后 2周内未发生再出血 ,临床有效率为 85 %。对 15例患者于套扎 2周后进行了内镜复查 ,其中 14例EV减轻 1级或 1级以上 ,内镜有效率为 93.3%。套扎术中大出血发生率 2 .4% ,术后食管溃疡形成期再出血发生率 15 % ,住院死亡率 2 .4% ,随访期内再出血发生率19 .4% ,随访期死亡率 9.7%。未见其它严重并发症。结论 本项疗法是治疗肝硬化EV破裂出血的有效手段 ,但潜在致命性大出血并发症的危险 ,远期疗效也不很理想。我们主张主要用于EV有活动性出血或近期有出血患者的止血治疗。
Objective To observe the efficacy and complications of endoscopic ligation of esophageal variceal bleeding. Methods 41 patients admitted to 1998 0 7-2 0 0 1 0 4 due to liver cirrhosis with EV rupture were treated with 5 serial ligature devices of the United States Microvasive Company. The curative effect and complication were followed-up average (7.5 4 ± 7.47) months. Results 16 cases of active hemorrhage during ligation, emergency hemostasis rate of 100%. All patients except one patient underwent liver transplantation after blood donation, 34 of 40 patients did not have rebleeding within 2 weeks after ligation, and the clinical effective rate was 85%. Fifteen patients underwent endoscopy 2 weeks after ligation. Eighteen of the 14 patients had an EV of 1 or more, and the endoscopic efficiency was 93.3%. The incidence of major bleeding in ligation was 2.4%, the incidence of rebleeding after formation of esophageal ulcer was 15%, the in-hospital mortality was 2.4%, the recurrence rate was 19.4% at follow-up, and the follow-up mortality rate was 9.7 %. No other serious complications. Conclusion This therapy is an effective method for the treatment of hemorrhagic cirrhosis with EV rupture. However, the risk of potentially fatal bleeding complications and long-term efficacy are not ideal. We advocate mainly for active bleeding in patients with EV or bleeding in patients with bleeding in the near future.