食管静脉曲张破裂出血内镜下结扎治疗远期疗效_医学论文.docVIP

食管静脉曲张破裂出血内镜下结扎治疗远期疗效_医学论文 食管静脉曲张破裂出血内镜下结扎治疗远期疗效_医学论文 作者：黄裕新，闻勤生，张少玲，穆琳 【关键词】 内镜结扎 　　关键词: 内镜结扎食管和胃静脉曲张肝硬化消化道出血 　　摘 要:目的 作者多年采用内镜下结扎治疗食管静脉曲张（EVL），研究远期疗效及并发症. 方法 住院肝硬化合并中重度食管静脉曲张破裂出血患者105例，在出血后72h或无出血时择期行EVL.结扎后分别在4wk，6mo，1和2a进行追踪及胃镜随访复查.4wk内结果作为近期疗效判断6mo以上结果作为远期疗效评价. 结果 静脉曲张近期根治率及总有效率分别为80%和86%.6mo后共随访到75例，其远期根治率及总有效率分别为51%和77%，与近期疗效比较有显著性差异（0.05）.而近期与远期再出血率及死亡率比较，无显著变化（Pgt0.05）. 结论 EVL近期疗效确切，安全可靠.但远期疗效并非乐观，常需重复行EVL治疗或进行手术治疗. 　　Keywords:endoscopic ligationesophagus and gastric varixliver cirrhosishemorrhage of digestive tract 　　Abstract:AIM To make a follow-up study of endoscopic esophagus varix ligation（EVL）cases in the past several years and evaluate their long-term effectiveness and complica┐tions.METHODS 105hospitalized patients of hepato-cir-rhosis with moderate and serious hemorrhagic varix of esoph-agus underwent EVL at72h after bleeding or at a time when no bleeding was observed.Follow-up study and gastroscopy were made of the patients at4weeks，6months，1year and2 years after the EVL.Results of the follow-up observations at4weeks were classified as evaluation of short-term effective-nessand those at6months or later were classified as evalua-tion of long-term effectiveness.RESULTS Short-term and total cure rates of esophagus varix were80%and86%re-spectively.75cases were followed up at6months，whose long-term and total cure rates were51%and77%respective-ly.There was a significant difference between the short-term cure rates and long-term cure rates（0.05）whereas no significant difference（0.05）was observed between short-term and long-term bleeding rates and death rates.CONCLUSION Short-term cure rate of EVL is distinct，safe and reliable whereas long-term cure rate is not so desir-able for which another EVL or surgical operation is needed. 　　0 引言 　　食管静脉曲张内镜下结扎治疗术（endosopic variceal ligation，EVL）是近年来国内外用于治疗食管静脉曲张破裂出血的新方法.目前，对其近期疗效的临床研究已有较多报道 ［1-4］ .但对其远期疗效的临床评价国内尚缺少专文报告.我们结合多年来实施EVL治疗食管静脉曲张病例，对其进行了随访观察，并对远期疗效及其并发症等作一综合评价. 　　1 材料和方法 　　1.1 材料