Background Endoscopic esophageal varices ligation( EVL)is an effective method of preventing liver cirrhosis patients′ esophageal variceal from rupture and rebleeding. However,the optimal interval time of EVL is still unclear. Objective To compare the effectiveness and safety of EVL at one - month and two - week intervals in preventing patients with liver cirrhosis from rebleeding. Methods Liver cirrhosis patients with acute esophageal variceal bleeding who were treated at Beijing Youan Hospital,Capital Medical University from January 2009 to October 2012 were selected as research objects and randomly divided into one - month interval group and two - week interval group using sealedopaque envelopes. The pathogenesis, symptoms,signs,situation of endoscopic active bleeding and gastric varices of patients,levels of Alb,TBiL,AST,ALT,PT were recorded,the disease severity of patients was assessed by Child-Pugh grading criteria,model for end - stage liver disease (MELD)and Beppu scoring system. Patients who were admitted to hospital within 12 hours received emergency EVL treatment, the interval period of one - month interval group performing EVL was 28 d,and that of two - week interval group was 2 weeks. Postoperative follow - up was made to patients,the primary endpoint was rebleeding,and secondary endpoints were esophageal variceal recurrence,EVL - related adverse events and death. Results 70 patients were finally recruited,and each group had 35 cases. There was no significant difference in occurrence rate of rebleeding between two groups(P > 0. 05). AST level was an independent influence factor of liver cirrhosis patients post - EVL developing rebleeding〔HR = 1. 02,95% CI(1. 00,1. 03), P = 0. 012〕. There was no significant difference in the recurrence rate of esophageal varices between two groups(P > 0. 05). There were no significant difference in the incidence of chest pain,sternal pain and dysphagia/ pain between two groups(P >0. 05). The incidence of ulceration after EVL in two - week interval group was higher than that in one - month interval group〔57. 1% (20 / 35)vs. 11. 4% (4 / 35),P < 0. 001〕. There was no significant difference in fatality rate of patients between two groups(P > 0. 05). Child-Pugh grading was an influence factor for post - EVL death in patients with liver cirrhosis〔 HR= 2. 95,95% CI(1. 06,8. 21),P = 0. 039〕. Conclusions The effects of EVL at one - month and two - week intervals on preventing liver cirrhosis patients from rebleeding,recurrence of esophageal varices and death are equivalent,but the occurrence rate of post - EVL ulcerous of patients underwent EVL at two - week interval is higher than that of patients underwent EVL at one- month interval.%背景内镜下食管静脉曲张套扎术（EVL）为有效预防肝硬化食管静脉曲张破裂再出血的方法。然而，最佳 EVL 间隔时间仍不清楚。目的比较间隔1个月和两周行 EVL 预防肝硬化患者再出血的有效性和安全性。方法选取2009年1月—2012年10月于首都医科大学附属北京佑安医院治疗的肝硬化急性食管静脉曲张破裂出血患者为研究对象，采用密闭信封法随机分为每月组和两周组。记录患者病因、症状、体征、内镜下活动性出血、胃底静脉曲张情况，检测静脉血清蛋白、总胆红素、天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）水平及凝血酶原时间，采用Child-Pugh分级标准、终末期肝病模型（MELD）和 Beppu 评分系统评价患者疾病严重程度。患者入院12 h内行急诊 EVL 治疗，每月组行 EVL 的间隔时间为28 d，两周组行 EVL 的间隔时间为两周。术后对患者进行随访，主要终点是再出血，次要终点是食管静脉曲张复发、EVL 相关不良事件和死亡。结果本研究共入选70例患者，两组各35例。两组再出血发生率比较，差异无统计学意义（P >0.05）。AST 水平是肝硬化患者 EVL 后再出血的独立影响因素〔HR =1.02，95% CI（1.00，1.03），P =0.012〕。两组食管静脉曲张复发率比较，差异无统计学意义（P >0.05）。两组胸闷、胸骨后疼痛、吞咽困难/疼痛发生率比较，差异均无统计学意义（P >0.05）。两周组 EVL 后溃疡发生率高于每月组〔57.1%（20/35）与11.4%（4/35），P <0.001〕。两组患者病死率比较，差异无统计学意义（P >0.05）。Child-Pugh分级是肝硬化患者 EVL 后死亡的影响因素〔HR =2.95，95% CI（1.06，8.21），P =0.039〕。结论 EVL 间隔时间为1个月和两周在预防肝硬化患者再出血、食管静脉曲张复发及死亡方面效果相当，但间隔两周行 EVL 的患者EVL 后溃疡的发生率高于间隔时间为1个月的患者。
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