经胃镜结扎对食管曲张静脉的影响和对出血预防的意义.docVIP

　　经胃镜结扎对食管曲张静脉的影响和对出血预防的意义 【摘要】 目的 研究肝硬化并食管静脉曲张上消化道大出血病人经胃镜食管静脉套扎（EVL）术前后食管静脉曲张程度的变化，分析EVL对预防和治疗肝硬化并食管静脉曲张上消化道大出血的意义。方法 对所有急诊止血和择期套扎病人手术前、手术后均作食管曲张静脉的直径及长度测量，前后进行比较分析；将观察的近四年分为两个时段，前两年急诊结扎次数与开展择期套扎的后两年急诊次数进行比较。结果 首次手术者315例，术后复查胃镜者共88例， 套扎一次复查61例，术前食管曲张静脉长度为(14.59±3.76)cm,直径为(9.16±1.91)mm，追踪平均6个月,术后长度(7.15±5.58)cm,直径为(3.84±3.15)mm；套扎多次复查27例,术前长度为(15.00±2.50) cm，直径为(10.22±1.34) mm，追踪平均17月,术后长度为 (8.04±6.10) cm，直径为(4.00±2.80) mm，手术前后比较均P＜0.01；曲张达Ⅳ度者手术前在扎1次病人中占42%(25/60),每例平均扎8.65点,在结扎多次病人中占71%(19/27),每例平均扎21点,两组比较P＜0.01,前二年急诊率33.14%(57/172)明显高于后二年的14.04%(32/228)。结论 EVL是目前治疗和预防肝硬化合并食管静脉曲张破裂出血首选且有效的方法；套扎疗效与套扎次数及点数相关；择期手术可明显减少肝硬化并食管静脉曲张破裂出血的机率。 【关键词】 肝硬化 食管静脉曲张 EVL 【Abstract】 objective:To investigate the variation of cirrhosis patients assive hemorrhage of gastrointestinal tract before and after gastroscope esophageal varicose vein ligation, to analysis the influences of preventing and treating esophageal varices and massive hemorrhage of gastrointestinal tract by gastroscope ligation.Method:For all emergency stop bleeding and haing electie patients before surgery, influence after surgery eter and length measurement, Before and after the parison and analysis, es and the conduct of elective ligation tergency number is used in the parison.Results: The first surgery 315 example, postoperative revie, The diameter m，observating about six months, the length of esophageal varicose vein after gastroscope esophageal varicose vein ligation , The diameter m; 27 ligated more than once，the length of esophageal varicose vein before gastroscope esophageal varicose vein ligation , The diameter m，observating about 17 months, the length of esophageal varicose vein after gastroscope esophageal varicose vein ligation , The diameter m.before-and-after Plt;0.01.Ⅳ degrees of the veins patients in ligation once patients before ligation ore than once ligation patients accounted for 71% (19/27), Every patient ligate about 21 points, parare to the Tergency rate of the first Tethod to treat and preve