程留芳 蔡逢春 王志强 令狐恩强 刘迎娣 100853 北京，解放军总医院消化科 中华肝脏病杂志 1998 0 0 2


    关键词：门脉高压 食管静脉曲张出血 介入治疗 期刊 zhgzbzz 0 门脉高压专栏 fur -->


    

【摘要】 目的 评估EVS、EVL、组织粘合剂注射及TIPSS治疗门静脉高压食管胃静脉曲张出血的优缺点。 方法 对712例食管胃静脉曲张出血病人进行了回顾分析。 结果 EVS 615例，经1 826次治疗，急诊止血率为96.9%，食管静脉曲张消失率为84.6%，并发症发生率为14.7%，肝硬化患者344人随访12～104月，1、3、5年生存率为91.52%±1.36%、71.42% ± 1.71、47.13% ± 1.86%。EVL 30例，食管静脉消失率为76.7%，复发出血13.3%。组织粘合剂注射12例，急诊6例全部止血。TIPSS治疗55例。成功率为90.9%食管静脉曲张消失和好转为82.3%并发症发生率为36%。一年内支架闭塞、狭窄、复发出血16例(38.09%)，随访12～42月，死亡12人(21.8%)。 结论 内镜下介入治疗是食管静脉曲张出血首选方法。急诊止血以EVS和内镜下组织粘合剂注射为优，EVL浸润性并发症低，但反复出血率较高，TIPSS治疗中远期疗效不佳。

    

INTERVENTIONAL TREATMENTOF ESOPHAGOGASTRIC VARICES HEMORRHAGE

Cheng Liufang, Cai Fengchun,Wang Zhiqiang, et al. Department of Gastroenterology, Chinese PLA General Hospital,Beijing, 100853

【Abstract】 Objective Toevaluate effects of EVS, EVL, cyanocrylate injection and TIPSS on esophageal varicealhemorrhage. Methods From April 1987 to December 1996, 712 patients with esophagealvariceal hemorrhage were analysed in retrospect. Results Among the patients, 615 cases were treated for a total of 1826sessions by EVS. The control rate of acute bleeding was 96.9%. Esophageal varices werecompletely eradicated in 84.6% of patients. The complication of EVS occurred in 14.7%.There were 344 patients with hepatic cirrhosis followed up for 12 to 104 months. Thesurvival rates of them in 1, 3 and 5 years were 91.52% ± 1.36%, 71.42%± 1.71% and 47.13%± 1.86%.respectively. There were 30 patients treated by EVL. Esophageal varices were completelyeradicated in 76.7%. Recurrent rebleeding occurred in 13.3%. Twelve patients were treatedby cyanoacrylate injection, arresting bleeding completely in 6 patients with emergencybleeding. Fifty-five patients were treated by TIPSS. The successful shunt was set up in90.9% patients. The eradicative rate of esophageal varices and the variceal improvementwas 82.3%. The complication of TIPSS occurred in 36% patients. Sixteen patients weredetected shunt stenosis of TIPSS occurred in 36% patients. Sixteen patients were detectedshunt stenosis or stent oclusion rebleeding within one year after TIPSS. Twelve(21.8%)patients died during follow-up 12～42 months. Conclusion Endoscopicinterventional therapy is a first elective technique of portal hypertension withesophageal variceal hemorrhage. EVS and cyanoacrylate injections are the best foremergency hemostasis. EVL has a low infiltrative complication, but with a high recurrentbleeding rate. The middle-or long-term efficacy after TIPSS is not satisfactory.

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