Mathur S K, Naik S R, Supe A N, Plumber S T, Pipalia S T, Bhalerao R A
Department of Surgery and Gastroenterology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Bombay, India.
Gastrointest Endosc. 1992 Mar-Apr;38(2):152-7. doi: 10.1016/s0016-5107(92)70381-2.
Endoscopic esophageal variceal sclerotherapy was performed in 301 patients with portal hypertension (emergency, 72 and elective, 229) using 3% aqueous phenol as sclerosant. The cause of portal hypertension was cirrhosis of the liver in 189 patients (Child's class A-48, B-66, and C-75), extrahepatic portal venous obstruction (EHPVO) in 90, and non-cirrhotic portal fibrosis in 22 patients. In the emergency group, active bleeding was controlled in 87% of cases. Re-bleeding occurred in 101 of 290 (35%) surviving patients. Obliteration of varices was achieved in 228 (84%) patients, with a mean of 5.14 +/- 2.27 sclerotherapy sessions. Of 301 patients, 29 (9.6%) had an early in-hospital mortality (30.5% in emergency and 3% in elective group), with 16 deaths due to variceal bleeding. Of the remaining 272 patients, 40 (15%) died during follow-up, of which only 11 died of variceal bleeding. Complications, such as superficial ulcers, dysphagia, and strictures, were observed in 14%, 7% of emergency, and 3% of elective patients. None of the patients developed systemic toxicity. In conclusion, 3% aqueous phenol is an effective, safe, and economical sclerosant for esophageal variceal sclerotherapy.
对301例门静脉高压患者(急诊72例,择期229例)进行了内镜下食管静脉曲张硬化治疗,使用3%的苯酚水溶液作为硬化剂。门静脉高压的病因包括189例肝硬化患者(Child分级A-48例、B-66例、C-75例)、90例肝外门静脉阻塞(EHPVO)以及22例非肝硬化性门静脉纤维化患者。在急诊组中,87%的病例活动性出血得到控制。290例存活患者中有101例(35%)再次出血。228例(84%)患者静脉曲张消失,平均硬化治疗疗程为5.14±2.27次。301例患者中,29例(9.6%)在住院早期死亡(急诊组为30.5%,择期组为3%),其中16例死于静脉曲张出血。其余272例患者中,40例(15%)在随访期间死亡,其中仅11例死于静脉曲张出血。急诊患者中有14%、择期患者中有7%和3%出现了诸如浅表溃疡、吞咽困难和狭窄等并发症。无一例患者发生全身毒性反应。总之,3%的苯酚水溶液是一种用于食管静脉曲张硬化治疗的有效、安全且经济的硬化剂。