肝硬化合并食管静脉曲张破裂出血二级预防不同序贯疗法治疗效果分析

发布时间：2018-03-14 04:44

本文选题：肝硬化　切入点：食管静脉曲张　出处：《首都医科大学学报》2016年05期 　论文类型：期刊论文

【摘要】：目的比较内镜下不同序贯治疗方法对肝硬化合并食管静脉曲张破裂出血(esophageal varices bleeding,EVB)二级预防的疗效。方法收集资料完整且明确诊断为肝硬化合并EVB(内镜下分级均为重度)且行内镜下治疗的62例患者,分为3组:套扎序贯套扎组22例,硬化剂序贯硬化剂组10例,套扎序贯硬化剂组30例。以上病例随访1年以上,若1年内出现大出血、死亡为终点并进行回顾性分析。详细记录所有病例相关合并症、5天治疗失败率、6周病死率、1年再出血率、平均住院时间以及费用等。结果 1)3组患者合并症例数比较,硬化剂序贯硬化剂组中食管狭窄及感染相对其他两组高,差异有统计学意义(P0.05)。2)5天治疗失败率、6周病死率在3种序贯方式比较中差异无统计学意义(P0.05),但在1年再出血率中,套扎序贯硬化剂组效果佳,未出现再出血情况。其他两组(套扎序贯套扎组、硬化剂序贯硬化剂组)再出血较高。3)3组不同序贯疗法间住院天数差异均有统计学意义(P0.05)。套扎序贯套扎组与硬化剂序贯硬化剂组的术中费用差异有统计学意义(P0.05)。3组比较,套扎序贯硬化剂组住院时间相对较短,费用较低。结论内镜下序贯治疗是治疗EVB的重要方法,套扎序贯硬化剂模式的5天治疗失败率和6周病死率,与另外两种序贯治疗模式相当,但1年再出血率低、医疗资源节约上具有更大的优势。
[Abstract]:Objective to compare the efficacy of different sequential endoscopic therapy in the secondary prevention of cirrhosis with esophageal variceal hemorrhage. Methods the data were collected and the diagnosis of cirrhosis with EVB was confirmed. Of 62 patients who received endoscopic treatment, The patients were divided into 3 groups: 22 cases in the sequential ligation group, 10 cases in the sclerosing agent group and 30 cases in the ligation sequential sclerosing agent group. Death was the end point and retrospective analysis was carried out. The failure rate of treatment for 5 days and the mortality rate of 6 weeks, rebleeding rate of 1 year, average hospitalization time and cost were recorded in detail. Results 1 the number of patients with complications was compared among the 3 groups. In the Sequential sclerosing agent group, the esophageal stenosis and infection were higher than those in the other two groups, and the difference was statistically significant (P 0.05). There was no significant difference in the 6-week mortality rate between the three sequential sclerosing agents, but there was no significant difference in the 1-year rebleeding rate. The effect of sequential sclerosing agent group was good, and no further bleeding occurred. The other two groups (ligation sequential ligation group, Sequential ligation group, There were significant differences in hospitalization days among different sequential therapy groups (P 0.05), and there was significant difference in intraoperative cost between sequential ligation group and sclerosing agent group (P 0.05). Conclusion Sequential endoscopic therapy is an important method for the treatment of EVB. It is similar to the other two sequential treatment modes, but the rate of rebleeding in one year is low, and the saving of medical resources has more advantages.
【作者单位】：武汉大学人民医院消化内科消化内镜中心湖北省消化疾病微创诊治医学临床研究中心;
【基金】：湖北省卫生和计划生育委员会西医类一般项目(WJ2015MB091)~~
【分类号】：R575.2

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