内镜下密集套扎法治疗食管静脉曲张破裂出血的效果观察

崔美兰; 贾彦生; 闫会敏; 康海燕; 王艳; 殷树英; 郑欢伟

doi:10.3969/j.issn.1001-5256.2018.08.018

内镜下密集套扎法治疗食管静脉曲张破裂出血的效果观察

DOI: 10.3969/j.issn.1001-5256.2018.08.018

河北省石家庄市第五医院

基金项目:

河北省卫生厅2016年医学科学研究重点课题计划(20160783)；

详细信息

中图分类号: R575.2
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出版历程
- 收稿日期: 2017-12-23
- 出版日期: 2018-08-20

Clinical effect of endoscopic dense ligation in treatment of esophageal variceal bleeding

Shijiazhuang Fifth Hospital

Research funding:

摘要

摘要: 目的观察内镜下密集套扎法治疗食管静脉曲张破裂出血的临床疗效。方法选取石家庄市第五医院2015年7月-2016年6月因肝硬化门静脉高压食管静脉曲张破裂出血首次行内镜下套扎治疗的156例患者的临床资料,根据治疗方法不同分为密集套扎组（n=76）和非密集套扎组（n=80）。对患者随访观察12年,统计患者的静脉曲张根除或基本消失率、套扎次数、早期再出血率、迟发性再出血率及不良反应发生率等。计量资料2组间比较采用t检验;计数资料2组间比较采用χ2检验或Fisher精确检验。结果密集套扎组与非密集套扎组静脉曲张根除或基本消失率（71.05%vs 55.00%）、套扎次数比较,差异均有统计学意义（χ2值分别为4.300、8.511,P值分别为0.038、0.014）,2组患者早期再出血率（5.26%vs 2.50%）、迟发性再出血率（7.89%vs10.00%）、静脉曲张复发率（13.16%vs 18.75%）及不良反应发生率（26.32%vs 21.25%）比较,差异均无统计学意义（P值均>0.05）;静脉曲张复发时间比较,差...
- 肝硬化 /
- 食管和胃静脉曲张 /
- 结扎术 /
- 治疗结果
Abstract: Objective To investigate the clinical effect of endoscopic dense ligation in the treatment of esophageal variceal bleeding. Methods A total of 156 patients who underwent endoscopic ligation for the first time due to esophageal variceal bleeding caused by cirrhotic portal hypertension in Shijiazhuang Fifth Hospital from July 2015 to June 2016 were enrolled, and according to the treatment method, they were divided into dense ligation group with 76 patients and non-dense ligation group with 80 patients. The patients were followed up for 1-2 years, and a statistical analysis was performed for the eradication or disappearance rate of varices, the number of times of ligation, early rebleeding rate, late-onset rebleeding rate, and the incidence rate of adverse reactions. The t-test was used for comparison of continuous data between two groups, and the chi-square test or Fisher's exact test was used for comparison of categorical data between two groups. Results There were significant differences between the dense ligation group and the non-dense ligation group in the eradication or disappearance rate of varices ( 71. 05% vs 55. 00%, χ2= 4. 300, P = 0. 038) and number of times of ligation ( χ2= 8. 511, P = 0. 014) , and there were no significant differences between the two groups in early rebleeding rate ( 5. 26% vs 2. 50%, P > 0. 05) , late-onset rebleeding rate ( 7. 89% vs 10. 00%, P > 0. 05) , recurrence rate of varices ( 13. 16% vs 18. 75%, P > 0. 05) , and incidence rate of adverse reactions ( 26. 32% vs 21. 25%, P > 0. 05) . There was a significant difference in the time to recurrence of varices between the two groups ( 11. 90 ±1. 89 months vs 7. 07 ± 1. 17 months, t = 2. 295, P = 0. 031) . Of all 156 patients, 2 ( 1. 28%) died during follow-up, with 1 patient in the dense ligation group and 1 in the non-dense ligation group. There was no significant difference in mortality rate between the two groups ( P > 0. 05) . Conclusion Endoscopic dense ligation is a safe technique for the treatment of esophageal variceal bleeding and is better than non-dense ligation in terms of the disappearance rate of varices and number of times of ligation. Endoscopic dense ligation also allows a longer time to recurrence of varices than non-dense ligation.
- liver cirrhosis /
- esophageal and gastric varices /
- ligation /
- treatment outcome

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参考文献(30)

[1]Chinese Society of Hepatology, Chinese Medical Association;Chinese Society of Gastroenterology, Chinese Medical Association;Chinese Society of Endoscopy, Chinese Medical Association.Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J].J Clin Hepatol, 2016, 32 (2) :203-219. (in Chinese) 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].临床肝胆病杂志, 2016, 32 (2) :203-219.

[2]HERRERA JL.Management of acute variceal bleeding[J].Clin Liver Dis, 2014, 18 (2) :347-357.

[3]de FRANCHIS R, Baveno VI Faculty.Expanding consensus in portal hypertension:Report of the Baveno VI Consensus Workshop:Stratifying risk and individualizing care for portal hypertension[J].J Hepatol, 2015, 63 (3) :743-752.

[4] Committee of esophageal varicosity, Society of Digestive Endoscopy of Chinese Medical Association.Tentative guidelines for endoscopic diagnosis and treatment of varicosity and variceal bleeding in digestive tract (2009) [J].Chin J Dig Endosc, 2010, 27 (1) :1-4. (in Chinese) 中华医学会消化内镜学分会食管胃静脉曲张学组.消化道静脉曲张及出血的内镜诊断和治疗规范试行方案 (2009年) [J].中华消化内镜杂志, 2010, 27 (1) :1-4.

[5] Chinese Society of Gastroenterology, Chinese Medical Association;Chinese Society of Hepatology, Chinese Medical Association;Chinese Society of Endoscopy, Chinese Medical Association.Consensus on prevention and treatment for gastroesophageal varices and variceal hemorrhage in liver cirrhosis (2008, Hangzhou) [J].Chin J Dig, 2008, 28 (8) :551-558. (in Chinese) 中华医学会消化病学分会, 中华医学会肝病学分会, 中华医学会内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治共识 (2008, 杭州) [J].中华消化杂志, 2008, 28 (8) :551-558.

[6]CHEN P.Clinical effect of endoscopic ligation of esophageal veins in treatment of esophageal variceal bleeding:An analysis of 67 cases[J].Shandong Med J, 2011, 51 (7) :69-70. (in Chinese) 陈萍.内镜下食管静脉结扎术治疗食管静脉曲张破裂出血67例分析[J].山东医药, 2011, 51 (7) :69-70.

[7]DAI C, LIU WX, JIANG M, et al.Endoscopic variceal ligation compared with endoscopic injection sclerotherapy for treatment of esophageal variceal hemorrhage:A meta-analysis[J].World J Gastroenterol, 2015, 21 (8) :2534-2541.

[8]ZHANG DX, LUO ZY.Clinical effect of esophageal variceal ligation in treatment of esophageal variceal bleeding in patients with liver cirrhosis[J].J Clin Hepatol, 2017, 33 (1) :76-81. (in Chinese) 张东旭, 骆子义.食管静脉曲张套扎术治疗肝硬化食管静脉曲张破裂出血的效果观察[J].临床肝胆病杂志, 2017, 33 (1) :76-81.

[9]YE ZS, CHEN LG.Clinical effect of endoscopic variceal ligation in treatment of patients with severe esophageal varices[J].Chin Foreign Med Res, 2016, 14 (32) :36-37. (in Chinese) 叶震世, 陈立刚.内镜下曲张静脉套扎用于食管静脉重度曲张患者治疗的临床效果[J].中外医学研究, 2016, 14 (32) :36-37.

[10]XUE DY, QU SX, WANG L, et al.Clinical effect of endoscopic dense versus non-dense ligation in treatment of severe esophageal varices[J].Chin Community Doct, 2012, 14 (17) :140-141. (in Chinese) 薛冬云, 曲少贤, 王玲, 等.内镜密集与非密集套扎治疗重度食管静脉曲张的疗效比较[J].中国社区医师, 2012, 14 (17) :140-141.

[11]ZHANG H, YAN DM, FAN HZ.Application of endoscopic variceal ligation in the treatment of patients with esophagus and gastric;varices bleeding:An analysis of sixty cases[J].J Pract Hepatol, 2013, 16 (4) :330-331. (in Chinese) 张鸿, 严冬梅, 范合璋.内镜下曲张静脉套扎治疗食管静脉重度曲张患者60例[J].实用肝脏病杂志, 2013, 16 (4) :330-331.

[12]YANG KZ, ZHU ZM, CHEN B.Comparison of the efficacy of non-dense ligation and dense ligation of esophageal varices on patients with severe esophageal varices[J].J Hunan Normal Univ:Med Sci, 2017, 14 (6) :133-135. (in Chinese) 杨昆政, 朱增民, 陈波.内镜下非密集套扎与密集套扎对重度食管静脉曲张的疗效比较[J].湖南师范大学学报:医学版, 2017, 14 (6) :133-135.

[13]GARCIA-PAGAN JC, REVERTER E, ABRALDES JG, et al.Acute variceal bleeding[J].Semin Respir Crit Care Med, 2012, 33 (1) :46-54.

[14]LEE SW, LEE TY, CHANG CS.Independent factors associated with recurrent bleeding in cirrhotic patients with esophageal variceal hemorrhage[J].Dig Dis Sci, 2009, 54 (5) :1128-1134.

[15]XU L, JI F, XU QW, et al.Risk factors for predicting early variceal rebleeding after endoscopic variceal ligation[J].World J Gastroenterol, 2011, 17 (28) :3347-3352.

[16]ZHOU JN, WEI Z, SUN ZQ.Risk factors for early rebleeding after esophageal variceal ligation in patients with liver cirrhosis[J].Chin J Hepatol, 2016, 24 (7) :486-492. (in Chinese) 周嘉宁, 魏志, 孙自勤.肝硬化食管静脉曲张套扎后早期再出血相关危险因素的多中心研究[J].中华肝脏病杂志, 2016, 24 (7) :486-492.

[17]JIN Y, WANG X, ZHANG LJ, et al.Risk factors for early rebleeding after esophageal variceal ligation in patients with liver cirrhosis[J].J Clin Hepatol, 2017, 33 (11) :2147-2151. (in Chinese) 金燕, 王雪, 张玲娟, 等.肝硬化患者食管静脉曲张套扎术后早期再出血的危险因素分析[J].临床肝胆病杂志, 2017, 33 (11) :2147-2151.

[18]GU C, LI L, WANG J, et al.Study on efficacy of endoscopic ligation therapy for esophageal varices and risk factors for postoperative rebleeding[J].J Clin Hepatol, 2014, 30 (12) :1279-1282. (in Chinese) 古川, 李璐, 王军, 等.内镜下套扎术治疗肝硬化食管静脉曲张的疗效及术后再出血的危险因素分析[J].临床肝胆病杂志, 2014, 30 (12) :1279-1282.

[19]LUZ GO, MALUF-FILHO F, MATUGUMA SE, et al.Comparison between endoscopic sclerotherapy and band ligation for hemostasis of acute variceal bleeding[J].World J Gastrointest Endosc, 2011, 3 (5) :95-100.

[20]ZHANG JP, JIANG LY, SHEN YJ.Endoscopic ligation of multiple serial for treatment of esophageal varices[J].J Changchun Univ Chin Med, 2016, 32 (4) :816-818. (in Chinese) 张金萍, 姜连英, 沈玉杰.内镜下多连环结扎术治疗食管静脉曲张的护理[J].长春中医药大学学报, 2016, 32 (4) :816-818.

[21]AUGUSTIN S, GONZALEZ A, GENESCAJ.Acute esophageal variceal bleeding:Current strategies and new perspectives[J].World J Hepatol, 2010, 2 (7) :261-274.

[22]LUO CQ, LI M, LI MH, et al.Comparison of endoscopic dense ligation and spiral ligation on esophageal varices[J].Mod Digest Interv, 2009, 14 (3) :153-155. (in Chinese) 罗炽权, 李明, 李明华, 等.密集套扎法与螺旋形套扎法治疗食管静脉曲张的疗效对比[J].现代消化及介入诊疗, 2009, 14 (3) :153-155.

[23]PEREZ-AYUSO RM, VALDERRAMA S, ESPINOZA M, et al.Endoscopic band ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhotic patients with high risk esophageal varices[J].Ann Hepatol, 2010, 9 (1) :15-22.

[24]LAHBABI M, MELLOUKI I, AQODAD N, et al.Esophageal variceal ligation in the secondary prevention of variceal bleeding:Result of long term follow-up[J].Pan Afr Med J, 2013, 15:3.

[25]FRANCO MC, GOMES GF, NAKAO FS, et al.Efficacy and safety of endoscopic prophylactic treatment with undiluted cyanoacrylate for gastric varices[J].World J Gastrointest Endosc, 2014, 6 (6) :254-259.

[26]MASALAITE L, VALANTINAS J, STANAITIS J.The role of collateral veins detected by endosonography in predicting the recurrence of esophageal varices after endoscopic treatment:A systematic review[J].Hepatol Int, 2014, 8 (3) :339-351.

[27]TRIANTOS C, KALAFATELI M.Endoscopic treatment of esophageal varices in patients with liver cirrhosis[J].World J Gastroenterol, 2014, 20 (36) :13015-13026.

[28]MOSTAFA EF, MOHAMMAD AN.Incidence and predictors of rebleeding after band ligation of oesophageal varices[J].Arab J Gastroenterol, 2014, 15 (3-4) :135-141.

[29]KAPOOR A, DHAREL N, SANYAL AJ.Endoscopic diagnosis and therapy in gastroesophageal variceal bleeding[J].Gastrointest Endosc Clin N Am, 2015, 25 (3) :491-507.

[30]LO EA, WILBY KJ, ENSOM MH, et al.Use of proton pump inhibitors in the management of gastroesophageal varices:A systematic review[J].Ann Pharmacother, 2015, 49 (2) :207-219.

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