内镜下食管静脉曲张套扎术治疗肝硬化食管静脉曲张56例疗效观察

发布时间：2018-07-26 19:06

【摘要】：目的探讨食管镜下食管静脉曲张套扎术(EVL)治疗肝硬化食管静脉曲张的疗效。方法食管静脉曲张患者56例,其中急性食管静脉出血32例;无临床症状者24例,均为中重度食管静脉曲张,为一二级预防者。56例均行EVL,术后4~6周评价疗效,观察术后并发症发生情况。结果急性出血32例中止血成功31例(96.87%),72 h内止血失败1例(3.12%),术后72 h~6周4例(12.5%)出血复发;24例无临床症状者未发生静脉破裂出血。术后4~6周50例获得随访,复查胃镜,静脉曲张根除35例(70%),基本消失15例(30%)。56例中,2例术后3 d出血复发,其中急性食管静脉曲张出血患者1例,重度静脉曲张一级预防者1例,经及时扩容、制酸、降门脉压等药物治疗后好转,后再次行EVL止血。术后出现胸骨后疼痛12例,吞咽困难5例,恶心不适4例,发热5例,未做特殊处理,自行缓解。无术后食管穿孔、狭窄者。结论 EVL治疗肝硬化食管静脉曲张疗效较好。术中规范操作、加强围术期管理可提高手术效果并减少并发症。
[Abstract]:Objective to evaluate the efficacy of esophageal variceal ligation (EVL) under esophagoscope in the treatment of esophageal varices due to cirrhosis. Methods Fifty-six patients with esophageal varices, including 32 patients with acute esophageal vein hemorrhage, 24 patients with moderate and severe esophageal varices without clinical symptoms, and 56 patients with grade one and two grade prophylaxis, were treated with EVL.Therapeutic effects were evaluated 4 weeks after operation. The incidence of postoperative complications was observed. Results among 32 cases of acute hemorrhage, 31 cases (96.87%) were successful in hemostasis and 1 case (3.12%) failed in hemostasis within 72 hours. 50 cases were followed up 4 weeks 6 weeks after operation, 35 cases (70%) were eradicated by gastroscopy, 15 cases (30%) were basically disappeared, 2 cases had recurrent bleeding 3 days after operation, including 1 case of acute esophageal variceal hemorrhage and 1 case of primary prevention of severe varicose vein. After timely dilatation, acidmaking, reducing portal pulse pressure and other drugs after the improvement, and then EVL hemostasis. Postoperative poststernal pain occurred in 12 cases, dysphagia in 5 cases, nausea and discomfort in 4 cases, fever in 5 cases. No postoperative perforation of esophagus, stenosis. Conclusion EVL is effective in the treatment of esophageal varices due to cirrhosis. Standard operation during operation and strengthening perioperative management can improve the effect of operation and reduce complications.
【作者单位】：衡阳市第一人民医院;
【分类号】：R575.2

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