摘要
Abstract
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.关键词
食管和胃静脉曲张/内镜下食管静脉曲张套扎术/间隔时间/出血/复发/随机对照试验Key words
Esophageal and gastric varices/Endoscopic esophageal variceal ligation/Interval time/Bleeding/Recurrence/Randomized controlled trial分类
医药卫生
