目的 观察内镜联合药物治疗方案对急性食管胃静脉曲张出血(EGVB)患者止血效果、再出血率及并发症发生风险的影响.方法 采用回顾性研究方法,收集2015年6月至2017年6月在延安大学附属医院就诊的EGVB患者100例,按治疗方法不同分为内镜硬化和套扎组以及经颈静脉肝内门体分流术(TIPS)组,每组50例.TIPS组采用TIPS治疗;内镜硬化和套扎组行内镜下曲张静脉硬化剂注射术和内镜下食管静脉曲张套扎术,术后口服非选择性β受体阻滞剂.记录患者急性期止血、再出血、生存情况和并发症发生率.治疗前和治疗后2周,检测两组患者血清白蛋白(Alb)、总胆红素(TBil)、血小板计数(PLT)等水平.结果 内镜硬化和套扎组止血成功率显著高于TIPS组〔98.0%(49/50)比82.0% (41/50)〕,且静脉曲张复发率、1年和2年再出血率以及并发症发生率均显著低于TIPS组〔静脉曲张复发率:6.0% (3/50)比24.0 (12/50),1年再出血率:12.0%(6/50)比30.0%(15/50),2年再出血率:42.0%(21/50)比66.0%(33/50),食道溃疡:2.0%(1/50)比14.0%(7/50),上腹部不适:2.0%(1/50)比14.0%(7/50),肝性脑病:4.0%(2/50)比16.0%(8/50),胸痛:6.0% (3/50)比20.0%(10/50),均P＜0.05〕.治疗后内镜硬化和套扎组Alb、PLT水平较TIPS组升高〔Alb(g/L):43.84±4.34比40.83±3.21,PLT (×109/L):26.33±3.37比21.12±3.89,均P＜0.05〕,TBil较TIPS组降低(μmol/L:13.82±4.32比19.33±4.59,P＜0.05).结论 内镜药物治疗方案能显著提高急性EGVB患者的止血效果,再出血率与TIPS相比并不增加,且并发症发生率显著低于TIPS术治疗.%Objective To observe the effects of endoscopic drug therap on hemostasis, re-bleeding and the risk of occurrence of complication in patients with acute esophageal and gastric variceal bleeding (EGVB). Methods A retrospective method was conducted, and 100 patients with EGVB who were admitted to the Affiliated Hospital of Yan'an University from June 2015 to June 2017 were enrolled. According to the difference in treatment methods, they were divided into an endoscopy Sclerotherapy and Ligation group and transjugular intrahepatic portosystemic shunt (TIPS) group, 50 cases in each group. The TIPS group was treated with TIPS; the endoscopy Sclerotherapy and Ligation group underwent endoscopic variceal sclerotherapy, endoscopic esophageal variceal ligation and postoperative non-selective β blockers oral administration. After 2 years of follow-up, the patients' hemostasis, re-bleeding at acute stage, survival situation and the incidences of complications were recorded. Before treatment and 2 weeks after treatment, the levels of serum albumin (Alb), total bilirubin (TBil) and platelet count (PLT) were measured by Hitachi automatic biochemical analyzer in the two groups. Results The success rate of hemostasis in the endoscopy Sclerotherapy and Ligation group was significantly higher than that in the TIPS group [98.0% (49/50) vs. 82.0% (41/50) ], and the recurrence rate of varices, during 1- and 2-year follow-up, the recurrence rate of bleeding and the incidences of complications were significantly lower than those in TIPS group [the recurrence rate of varicose veins: 6.0% (3/50) vs. 24.0 (12/50), 1-year re-bleeding rate: 12.0% (6/50) vs. 30.0% (15/50), 2-year re-bleeding rate: 42.0% (21/50) vs. 66.0% (33/50), esophageal ulcer: 2.0% (1/50) vs. 14.0% (7/50), upper abdominal discomfort: 2.0% (1/50) vs. 14.0% (7/50), hepatic encephalopathy:4.0% (2/50) vs. 16.0% (8/50), chest pain: 6.0% (3/50) vs. 20.0% (10/50), all P < 0.05]. After treatment, the levels of Alb and PLT in the endoscopy Sclerotherapy and Ligation group were higher than those in the TIPS group [Alb (g/L):43.84±4.34 vs. 40.83±3.21, PLT (×109/L): 26.33±3.37 vs. 21.12±3.89, both P < 0.05], and the TBil was lower than that in the TIPS group (μmol/L: 13.82±4.32 vs. 19.33±4.59). Conclusion Endoscopic Sclerotherapy and Ligation can significantly improve the effect of hemostasis of patients with acute EGVB, the rate of re-bleeding does not increase compared with that of western medicine group using TIPS, and the incidences of complications are significantly lower than those of applying TIPS.
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