黏膜硬化加固术预防食管静脉曲张复发的疗效观察(1)
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【摘要】 目的 探讨黏膜硬化加固术对套扎后食管静脉曲张复发的预防作用。方法 纳入257例食管静脉曲张破裂出血经套扎后曲张静脉消失的患者，将其随机的分为黏膜加固术组(139例)和单纯套扎术组(118例)。通过定期随访24～60个月，观察食管静脉曲张的复发率和并发症发生率。 结果 黏膜加固组静脉曲张复发率为43.9%，明显低于单纯套扎组(82.2%，P<0.05)。另外，黏膜加固术组行硬化加固治疗共达348次，并发症发生率为8.0%。 结论 黏膜硬化加固术能有效降低套扎术后食管静脉曲张复发，是一种能提高远期疗效的内镜治疗方法。
【关键词】 食管静脉曲张；黏膜硬化加固术；内镜下套扎术
Efficacy of the mucosal reinforcement for preventing the recurrence of esophageal varices MU Hong,SUN Zi-qin.Taian Hospital of Traditional Chinese Medicine,271000,China
【Abstract】 Objective To investigate the efficacy of the mucosal reinforcement for preventing the recurrence of esophageal varices. Methods Two hundred and fifty-seven patients with disappearance of esophageal varices by ligation treatmentwere randomly divided into the sclerotherapy-enforcing group(139 patients)and endoscopic variceal ligation(EVL)group(118 patients). Through regular follow-up period ranged from 24 to 60 months, the variceal recurrence rate and complication rate were observed. Results The variceal recurrence rate was 43.9% in the sclerotherapy-enforcing group，which was significantly lower than that of endoscopic variceal ligation group(82.2%, P<0.05). There were three hundred and forty-eight times of endoscopic variceal slerotheropy in the sclerotherapy-enforcing group. Additionally, the percentage of complication rate was 8.0%. Conclusion Mucosal reinforcement therapy can effectively reduce the recurrence of esophageal varices after EVL. It may be a way to improve long-term efficacy of endoscopic therapy.
【Key words】 Esophageal varices; Mucosal reinforcement; Endoscopic variceal ligation
食管静脉曲张(Esophageal Varices, EV)破裂出血是肝硬化的严重并发症和常见致死原因之一。内镜下食管静脉曲张套扎(Endoscopic variceal ligation,EVL)和内镜下硬化治疗(Endoscopic variceal sclerotherapy,EVS)是食管静脉曲张破裂出血的主要有效治疗方法。与EVS相比，EVL更安全、有效，且并发症少，近几年已逐渐取代EVS，成为治疗食管静脉曲张破裂出血的首选内镜治疗方法[1～3]。但EVL的缺点是术后静脉曲张复发率高，远期疗效不尽理想，这是目前面临的难题。我们对经套扎术后曲张静脉消除的患者再行2～4次小剂量硬化剂黏膜加固治疗，术后重点观察静脉曲张复发率、并发症发生率，评价其降低套扎术后EV复发的疗效，探讨一种能提高远期疗效的内镜治疗方法。现报告如下。
1 资料与方法
1.1 一般资料 2004年1月至2007年3月于济南军区总院消化科住院确诊为食管静脉曲张破裂出血患者257例，经内镜下套扎治疗静脉曲张消失后纳入研究，并随机分为黏膜加固组139例和对照组(单纯套扎组)118例。两组一般情况见表1，具有可比性。除外胃底静脉曲张者。
1.2 治疗方法 使用FUJINON 450型电子胃镜；INJ1-A1-07.180型内镜注射针 ......
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