论文部分内容阅读
目的 :比较内镜下套扎术 (EVL)结合硬化剂注射 (EVS)和食管胃底静脉断流术对食管静脉曲张出血的近期和远期疗效。方法 :12例肝硬化门脉高压病人行食管胃底静脉断流术 ,其中 6例术后行EVL或EVS ;32例食管静脉曲张行EVL加EVS ;9例食管静脉曲张行EVL ;5例食管静脉曲张行EVS。所有病人术后随访 3～ 5年 ,观察复发和再出血情况。结果 :食管胃底静脉断流术对急性出血的止血效果肯定 ,但术后仍存在程度不同的曲张静脉 ,术后 3～ 5年内再出血发生率高达 6 6 7% (8/ 12 )。术后择期行EVL和EVS ,可以使曲张静脉完全消失 ,达到满意的远期疗效。EVL结合EVS后 ,曲张静脉完全消退 93 75 % (30 / 32 ) ,总疗程 2～ 3wk。内镜下治疗后 ,3～ 5年内曲张静脉复发率为 10 5 3 % (4/ 38) ,再出血发生率 6 5 2 % (3/ 46 )。结论 :EVL联合EVS对食管静脉曲张破裂出血的近期和远期疗效明显优于手术组。食管胃底静脉断流术后施行EVL或 (和 )EVS可以同时达到降低门脉压力和消除曲张静脉的目的 ;EVL结合EVS效果优于单纯用EVL或EVS治疗
Objective: To compare the short-term and long-term effects of endoscopic ligation (EVL) combined with sclerosing agent (EVS) and esophageal-gastric bypass on esophageal variceal bleeding. Methods: Twelve patients with portal hypertension were treated by esophageal and gastric fundus venous drainage. Among them, 6 cases were treated with EVL or EVS, 32 cases with esophageal varices with EVL plus EVS, 9 cases with esophageal varices with EVL, 5 cases with esophageal Varicose veins EVS. All patients were followed up for 3 to 5 years to observe the recurrence and rebleeding. Results: Esophageal and gastric venous drainage was effective in the hemostasis of acute hemorrhage. However, varicose veins with different degrees were still present after operation. The incidence of rebleeding within 3 to 5 years after operation was as high as 6 6 7% (8/12). Elective postoperative EVL and EVS, varicose veins can disappear completely, to achieve satisfactory long-term efficacy. EVL combined with EVS, varicose veins completely subsided 93 75% (30/32), the total course of 2 ~ 3wk. After endoscopic treatment, the recurrence rate of varicose vein was 105.3% (4/38) in 3 to 5 years, and the rate of rebleeding was 65.2% (3/46). Conclusion: The efficacy of EVL combined with EVS in the treatment of esophageal variceal bleeding is better than that of operation group in short-term and long-term. EVL or (and) EVS after esophago-gastric fundotomy can achieve the goal of reducing portal pressure and eliminating varicose veins at the same time; EVL combined with EVS is better than EVL or EVS alone