Diagnosis and treatment of primary bleeding from esophageal varices in cirrhotic patients from Yangzhou,China: an analysis of 80 cases
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摘要: 目的探讨扬州地区肝硬化食管静脉曲张初次出血患者诊治特点。方法回顾性分析2010年1月-2013年12月苏北人民医院消化内科收治的80例肝硬化食管静脉曲张初次出血患者病例资料。计数资料用率或构成比表示,率的比较采用χ2检验。结果由乙型肝炎导致肝硬化所引起的食管静脉曲张破裂出血所占比例最大;三腔二囊管临床运用可最大限度地挽救患者生命,为后期治疗提供时间;基础治疗包括止血、输血、抑酸、补液等,后期以硬化剂、套扎、硬化剂+套扎、手术、经颈静脉肝内门体分流术(TIPS)为主,但套扎运用最为广泛;患者出血初期各项指标变化有利于指导临床治疗,对患者预后具有良好的评估作用。结论扬州地区肝硬化引起的食管静脉曲张破裂出血病因呈现复杂交叉性,治疗方法仍需进一步完善,以达到个体化治疗水平;及时正确的救治,对提高临床疗效、降低病死率有重要意义;早期的健康体检,对疾病诊治起关键性的作用。Abstract: Objective To investigate the diagnosis and treatment of primary bleeding from esophageal varices( EVB) in cirrhotic patients from Yangzhou,China. Methods A retrospective analysis was performed on 80 cirrhotic patients with primary BEV who were treated at the Department of Gastroenterology,Northern Jiangsu People's Hospital,Yangzhou,China,from January 2010 to December 2013. Categorical data were expressed as rate or constituent ratio and comparison of the rate was performed using χ2test. Results Primary BEV caused by hepatitis B- related cirrhosis accounted for the largest proportion of patients under study. Clinical application of Sengstaken- Blakemore tubes saved the life of patients' to the maximum degree,which provided time for the following treatment. The basic treatment included hemostasis,blood transfusion,antacids,and fluid infusion,and the late treatment mainly included endoscopic variceal ligation( EVL),endoscopic variceal sclerotherapy( EVS),EVL + EVS,surgery,and transjugular intrahepatic portosystemic shunt,among which EVL was most widely used. Changes in hematologic indicators during early bleeding were useful for guiding clinical treatment and evaluating the prognosis of patients. Conclusion Cirrhosis- related primary BEV has complex causes in patients from Yangzhou,for whom the treatment still needs to be further improved to reach the individualized level. Timely and correct treatment has great implications for improving the clinical effect and reducing the mortality. Early physical examination plays a pivotal role in the diagnosis and treatment of the disease.
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