Lo Gin-Ho, Chen Wen-Chi, Chen Mei-Hsiu, Hsu Ping-I, Lin Chiun-Ku, Tsai Wei-Lun, Lai Kwok-Hung
Division of Gastroenterology, Department of Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan, Republic of China.
Gastroenterology. 2002 Sep;123(3):728-34. doi: 10.1053/gast.2002.35351.
BACKGROUND & AIMS: beta-blockers and banding ligation are effective in the prevention of variceal rebleeding. However, the relative efficacy and safety remains unresolved.
One hundred twenty-one patients with a history of esophageal variceal bleeding were enrolled. Patients were randomized to undergo regular endoscopic variceal ligation (EVL group, 60 patients) until variceal obliteration, or drug therapy by using nadolol plus isosorbide mononitrate (N+I group, 61 patients) during the study period to prevent rebleeding.
After a median follow-up period of 25 months, recurrent upper gastrointestinal bleeding developed in 23 patients in the EVL group and 35 patients in the N+I group (P = 0.10). Recurrent bleeding from esophageal varices occurred in 12 patients (20%) in the EVL group and 26 patients (42%) in the N+I group (relative risk = 0.45; 95% confidence interval, 0.24-0.85). The actuarial probability of rebleeding from esophageal varices was lower in the EVL group (P = 0.01). The multivariate Cox analysis indicated that the treatment was the only factor predictive of rebleeding. Treatment failure occurred in 8 patients (13%) in the EVL group and 17 patients (28%) in the N+I group (P = 0.01). Fifteen patients in the EVL group and 8 patients of the N+I group died (P = 0.06). Complications occurred in 17% of the EVL group and in 19% of the N+I group (P = 0.6).
Our trial showed that ligation was more effective than nadolol plus isosorbide-5-mononitrate in the prevention of variceal rebleeding, with similar complications in both treatment modalities. However, there is no significant difference in the survival rate between the 2 groups.
β受体阻滞剂和套扎术在预防静脉曲张再出血方面有效。然而，它们的相对疗效和安全性仍未明确。
纳入121例有食管静脉曲张出血史的患者。患者被随机分为两组，一组接受定期内镜下静脉曲张套扎术（套扎组，60例患者）直至静脉曲张闭塞，另一组在研究期间接受纳多洛尔加单硝酸异山梨酯药物治疗（N + I组，61例患者）以预防再出血。
中位随访25个月后，套扎组23例患者和N + I组35例患者出现复发性上消化道出血（P = 0.10）。套扎组12例患者（20%）和N + I组26例患者（42%）发生食管静脉曲张再出血（相对风险 = 0.45；95%置信区间，0.24 - 0.85）。套扎组食管静脉曲张再出血的精算概率较低（P = 0.01）。多因素Cox分析表明，治疗是预测再出血的唯一因素。套扎组8例患者（13%）和N + I组17例患者（28%）出现治疗失败（P = 0.01）。套扎组15例患者和N + I组8例患者死亡（P = 0.06）。套扎组17%的患者和N + I组19%的患者出现并发症（P = 0.6）。
我们的试验表明，在预防静脉曲张再出血方面，套扎术比纳多洛尔加5 - 单硝酸异山梨酯更有效，两种治疗方式的并发症相似。然而，两组的生存率无显著差异。
