目的 探讨肝硬化食管静脉曲张出血胃镜下套扎临床疗效.方法 回顾性分析204例肝硬化食管静脉曲张破裂出血病例,根据治疗方法分为三腔二囊管组(三腔管组)81例和曲张静脉套扎组(套扎组)123例,比较两组止血成功率、病死率、住院时间、并发症发生率、生存时间等.结果 套扎组72 h止血成功率100%高于三腔管组的84.0%(χ2=21.084,P＜0.01);套扎组无死亡患者,三腔管组死亡6例(χ2=9.387,P＜0.01);套扎组住院时间显著少于三腔管组;套扎组并发症为18.7%显著少于三腔管组的63.0%(χ2=41.394,P＜0.01);术后2 w复查,套扎组中度为60.0%(χ2=8.499,P＜0.01)及重度食管静脉曲张的66.2%(χ2=5.343,P＜0.05)均显著低于三腔管组.套扎组上消化道出血复发1次(χ2=30.997,P＜0.01)及2次以上比例显著低于三腔管组(χ2=19.088,P＜0.01);12个月内病死率显著低于三腔管组(χ2=21.113,P＜0.01);4年累计生存率(86.6%)显著高于三腔管组(22.3%).结论 肝硬化食管静脉曲张破裂出血套扎成功率高、并发症少、复发率低,是一种有效的治疗方法.%Objective To discuss the clinical curative effects of gastroscopic variceal ligation on esophageal variceal bleeding in cirrhotic patients. Methods A retrospective analysis was made among 204 cases of cirrhosis with esophageal variceal bleeding. The patients were divided into two groups according to the treatments they received: three - channel double - balloon catheter group( three -channel group, 81 cases )and variceal ligation group( ligation group, 123 cases ). Comparison was made in the achievement ratio of hemostasis, case fatality, length of stay, incidence rate of complications and live time between the two groups. Results The achievement ratio of hemostasis within 72 h in the ligation group( 100% )was higher than that in the three - channel group of 84.0% (X2 =21.084, P<0. 01 ). No patients died in the ligation group,but 6 patients died in the three - channel group(X2 =9. 387,P <0.01 ). The length of stay in the ligation group was significantly shorter than that in the three - channel group. The complications( 18. 7% )of the ligation group was significantly fewer than those of the three - channel group of 63.0%(X2 =41. 394,P <0. 01 ). In the reexamination 2 w after the operation,the proportions of moderate of 60.0%(X2 = 8. 499,P <0. 01 )and severe of 66. 2%(X2 =5. 343,P <0. 05 )esophageal varices in the ligation group were significantly lower than those in the three - channel group. In the ligation group, the proportions of one - time(X2 = 30. 997, P < 0. 01 )and two or more times recurrence of upper gastrointestinal bleeding were significantly lower than those in the three - channel group(X2 = 19. 088,P < 0.01 ). The case fatality of the ligation group was significantly lower than that of the three - channel group(X2 =21. 113 ,P <0. 01 ). The 4 - year accumulative survival rate of the ligation group( 86. 6% )was significantly higher than that of the three - channel group( 22. 3% ). Conclusion Gastroscopic variceal ligation has high achievement ratio, less complications and low relapse rate. It is an effective treatment for esophageal variceal bleeding in cirrhotic patients.
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