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目的探讨超声内镜(endoscopic ultrasonography,EUS)指导食管静脉曲张(esophageal varices,EV)内镜治疗方式及预测复发的意义。方法将急性EV出血患者随机分研究组(A组)41例,对照组(B组)40例,所有患者急诊(出血12~72 h)行食管静脉曲张套扎术(EVL),每2周再次行EVL至不能再套扎为止,第1次与最后1次行EVL 14 d后均行EUS观察有无食管旁静脉、食管周围静脉、穿静脉等。A组41例中36例见穿静脉,EUS指导1~2次食管静脉曲张硬化治疗(EIS)。B组40例中35例见穿静脉,对穿静脉不予处置。随访两组,均每3个月复查胃镜,6个月复查EUS,为期1年。结果 A组EUS指导EIS 1~2次后,穿静脉闭塞31例,未完全闭塞5例;B组2~3次EVL结束后穿静脉闭塞6例,未完全闭塞29例,差异有显著统计学意义(χ2=12.52,P=0.0004)。随访1年,A组复发16例,F2级5例,F1级11例,EUS显示均有穿静脉再通,无再出血者;B组复发34例,F3级3例,F2级16例,F1级15例,EUS显示穿通支增粗,食管周围静脉、食管旁静脉再生,且有2例分别于5个月、11个月再出血,给予EIS治疗止血。两组比较,复发率及复发严重程度差异均有统计学意义(P<0.05)。结论 EUS在EV出血治疗方法选择上有指导意义,对预测复发有一定的价值。
Objective To investigate the endoscopic ultrasonography (EUS) guidance of esophageal varices (EV) endoscopic treatment and prediction of recurrence. Methods Acute EV bleed was randomly divided into study group (A group) 41 cases, control group (B group) 40 cases, all patients emergency (bleeding 12-72 h) esophageal varices ligation (EVL), every 2 weeks Again EVL can no longer be ligated so far, the first and last EVL 14 days after the line EUS were observed with or without paraesophageal vein, esophageal vein, through the veins and so on. Thirty-six patients in group A received percutaneous transluminal thrombolysis and EUS guided one or two esophageal varices sclerosis (EIS). In group B, 35 cases were seen through veins, while no treatment was given to veins. All the patients were followed up for gastroscopy every 3 months and EUS for 6 months, with a duration of 1 year. Results In group A, EUS guided EIS 1 ~ 2 times, 31 cases of venous occlusion, 5 cases of incomplete occlusion; 6 cases of venous occlusion after 2 ~ 3 EVL in group B, 29 cases of incomplete occlusion, the difference was statistically significant Significance (χ2 = 12.52, P = 0.0004). All patients were followed up for one year. There were 16 cases of recurrence in group A, 5 cases of grade F2, 11 cases of grade F1, and EUS showed recanalization without rebleeding. There were 34 cases of recurrence in group B, 3 of grade F3, 16 of grade F2, F1 grade in 15 cases, EUS showed thickening of the perforation, esophageal peripheral vein, paraventricular paraventricular vein regeneration, and two cases were at 5 months, 11 months and then bleeding, giving EIS treatment of bleeding. The difference between the two groups was statistically significant (P <0.05). Conclusion EUS is instructive in the choice of treatment of EV bleeding and has some value in predicting recurrence.