内镜下聚桂醇硬化治疗重度食管静脉曲张破裂出血的效果观察

崔美兰; 贾彦生; 康海燕; 殷树英; 郑欢伟

doi:10.3969/j.issn.1001-5256.2017.12.013

内镜下聚桂醇硬化治疗重度食管静脉曲张破裂出血的效果观察

DOI: 10.3969/j.issn.1001-5256.2017.12.013

石家庄市第五医院肝病消化科

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
计量
- 文章访问数: 2079
- HTML全文浏览量: 73
- PDF下载量: 384
- 被引次数: 0
出版历程
- 收稿日期: 2017-05-02
- 出版日期: 2017-12-20

Efficacy of endoscopic sclerotherapy with lauromacrogol in treatment of severe esophageal variceal bleeding

Department of Liver Disease and Gastroenterology, The Fifth Hospital of Shijiazhuang

Research funding:

摘要

摘要: 目的观察内镜下聚桂醇硬化治疗肝硬化重度食管静脉曲张破裂出血的近、远期疗效。方法回顾性分析石家庄市第五医院2011年1月-2014年12月期间因肝硬化门静脉高压重度食管静脉曲张破裂出血首次行内镜下聚桂醇硬化治疗的患者160例,分为急诊治疗组（n=66）和择期治疗组（n=94）,对患者随访观察了15年,统计患者的止血成功率、近期再出血率、远期再出血率、并发症发生率等。计数资料2组间比较采用χ2检验或Fisher确切概率法,计量资料2组间比较采用t检验。结果急诊治疗组与择期治疗组止血成功率（98.48%vs 100.00%）、静脉曲张根除或基本消失率（74.24%vs 82.98%）、静脉曲张根除或基本消失时间[（21.4±0.3）d vs（20.5±0.3）d]、静脉曲张复发率（18.18%vs 15.96%）、静脉曲张复发时间[（17.0±1.8）月vs（19.2±2.3）月]、远期再出血率（33.33%vs 21.28%）及并发症发生率（22.73%vs 18.09%）比较,差异均无统计学意义（P值均>0.05）,近期再出血率（9.09%vs 1.06%）差...
- 食管和胃静脉曲张 /
- 聚桂醇 /
- 硬化疗法 /
- 治疗结果
Abstract: Objective To investigate the short-and long-term efficacy of endoscopic sclerotherapy with lauromacrogol in the treatment of cirrhotic patients with severe esophageal variceal bleeding. Methods A retrospective analysis was performed for the clinical data of 160 patients who underwent endoscopic sclerotherapy with lauromacrogol for the first time due to severe esophageal variceal bleeding caused by cirrhotic portal hypertension in The Fifth Hospital of Shijiazhuang from January 2011 to December 2014. These patients were divided into emergency treatment group with 66 patients and selective treatment group with 94 patients. All patients were followed up for 1-5 years, and a statistical analysis was performed for the success rate of hemostasis, short-term rebleeding rate, long-term rebleeding rate, and incidence of complications. The chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups, and the t-test was used for comparison of continuous data between two groups. Results There were no significant differences between the emergency treatment group and the selective treatment group in the success rate of hemostasis ( 98. 48% vs 100. 00%, P > 0. 05) , rate of eradication or disappearance of varices ( 74. 24% vs 82. 98%, P > 0. 05) , time to the eradication or disappearance of varices ( 21. 4 ± 0. 3 d vs 20. 5 ±0. 3 d, P > 0. 05) , variceal recurrence rate ( 18. 18% vs 15. 96%, P > 0. 05) , time to variceal recurrence ( 17. 0 ± 1. 8 months vs 19. 2 ±2. 3 months, P > 0. 05) , long-term rebleeding rate ( 33. 33% vs 21. 28%, P > 0. 05) , and incidence rate of complications ( 22. 73% vs18. 09%, P > 0. 05) , while there was a significant difference in short-term rebleeding rate between the two groups ( 9. 09% vs 1. 06%, P = 0. 020) . Of all 160 patients, 8 ( 5. 00%) died during follow-up, including 5 patients in the emergency treatment group ( one each died of esophageal variceal bleeding, multiple organ failure, and rupture and bleeding of liver cancer nodules, and 2 died of hepatic encephalopathy) and 3 in the selective treatment group ( one patient each died of esophageal variceal bleeding, multiple organ failure, and rupture and bleeding of liver cancer nodules) . Conclusion Endoscopic sclerotherapy with lauromacrogol has marked short-and long-term efficacy in the treatment of severe esophageal variceal bleeding, and short-term rebleeding after emergency treatment should be taken seriously.
- esophageal and gastric varices /
- lauromacrogol injection /
- sclerotherapy /
- treatment outcome

HTML全文

参考文献(15)

[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] 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.

[3]LIU LS, SHENG JW.Application of kangfuxin in prevention of recent rebleeding after esophageal variceal ligation[J].Pract Clin Med, 2013, 14 (9) :21-22, 34. (in Chinese) 刘良生, 盛建文.康复新在预防食管静脉曲张套扎术后近期再出血中的作用[J].实用临床医学, 2013, 14 (9) :21-22, 34.

[4]CHEN P.Clinical effect of endoscopic esophageal variceal ligation 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管静脉曲张破裂出血67例分析[J].山东医药, 2011, 51 (7) :69-70.

[5]MEI ZC, HE L, CHEN WQ, et al.Evaluation of the effects of dense endoscopic ligation for bleeding esophageal varices[J].Chin J Hepatol, 2005, 13 (4) :294-296. (in Chinese) 梅浙川, 何璐, 陈伟庆, 等.密集多点结扎术治疗食管静脉曲张出血的临床疗效观察[J].中华肝脏病杂志, 2005, 13 (4) :294-296.

[6] 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, 16 (8) :564-570. (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, 16 (8) :564-570.

[7]CHENG LF, WANG ZQ, CAI FC, et al.Retrospect of thirteen years’experience in sclerotherophy for esophageal variceal bleeding[J].Chin J Dig, 2001, 21 (11) :658-660. (in Chinese) 程留芳, 王志强, 蔡逢春, 等.食管静脉曲张出血硬化治疗十三年回顾[J].中华消化杂志, 2001, 21 (11) :658-660.

[8]YUE Y, TANG KY, SHAO LP, et al.Experience in the application of lauromacrogol in emergency treatment of esophageal variceal bleeding[J].J Huaihai Med, 2013, 31 (4) :351-352. (in Chinese) 岳玉, 汤克云, 邵利萍, 等.聚桂醇在急诊硬化治疗食管静脉曲张破裂出血中的应用体会[J].淮海医药, 2013, 31 (4) :351-352.

[9]LI BM, ZHU X, SHU X, et al.Endoscopic variceal ligation plus sclerotherapy for esophageal variceal bleeding[J].Chin J Dig Endosc, 2013, 30 (2) :67-70. (in Chinese) 李弼民, 朱萱, 舒徐, 等.肝硬化食管静脉曲张破裂出血序贯治疗的临床应用价值[J].中华消化内镜杂志, 2013, 30 (2) :67-70.

[10]DUAN Y, JIANG WW.Clinical effect of endoscopic lauromacrogol injection in treatment of esophageal varices:an analysis of 51 cases[J].China Prac Med, 2013, 8 (28) :191-192. (in Chinese) 段煜, 姜文文.51例内镜下注射聚桂醇硬化剂治疗食管静脉曲张疗效观察[J].中国实用医药, 2013, 8 (28) :191-192.

[11]ZHOU HH, XIANG XH, ZHANG MM.Diagnosis and treatment of primary bleeding from esophageal varices in cirrhotic patients from Yangzhou[J].J Clin Hepatol, 2015, 31 (3) :370-373. (in Chinese) 周宏华, 向晓星, 张描描.扬州地区肝硬化食管静脉曲张初次出血80例患者诊治分析[J].临床肝胆病杂志, 2015, 31 (3) :370-373.

[12]LIN XC, LIN W, CHENG LF, et al.Clinical effect of injection of high-dose sclerosing agent in treatment of esophageal and gastric varices[J].Shandong Med J, 2008, 48 (39) :101-102. (in Chinese) 林香春, 蔺武, 程留芳, 等.大剂量硬化剂注射治疗食管胃底静脉曲张疗效观察[J].山东医药, 2008, 48 (39) :101-102.

[13]WANG J, CHAI GJ, LIU YD.Formation of ulcer after esophageal variceal sc Ierotherapy and analysis of correlated factors[J].Chin JGastroenterol Hepatol, 2008, 17 (12) :1010-1012. (in Chinese) 王娟, 柴国君, 刘迎娣.食管静脉曲张硬化治疗后溃疡的发生及相关因素分析[J].胃肠病学和肝病学杂志, 2008, 17 (12) :1010-1012.

[14]MIAO LJ, SUN KW, WANG Y, et al.Retrospect of 12 years of emergent endoscopic varices sclerotherapy esophageal varices bleeding[J].Chin J Gastroenterol Hepatol, 2017, 26 (2) :181-183. (in Chinese) 苗鲁杰, 孙克文, 王扬, 等.急诊内镜下硬化治疗食管静脉曲张破裂大出血12年回顾[J].胃肠病学和肝病学杂志, 2017, 26 (2) :181-183.

[15]XU XY.Tendency of clinical treatment of gastroesophageal variceal bleeding in cirrhotic patients[J].J Pract Hepatol, 2013, 16 (3) :193-194. (in Chinese) 徐小元.肝硬化食管胃静脉曲张破裂出血的临床处理动向[J].实用肝脏病杂志, 2013, 16 (3) :193-194.

施引文献

资源附件(0)

访问统计