Urso G, Interlandi D, Puglisi M, Di Prima P, Bertino G, La Rosa G
Division of Emergency Medicine, Department of Internal Medicine, P.O. S. Marta Villermosa, University of Catania, Catania, Italy.
Minerva Gastroenterol Dietol. 2006 Sep;52(3):309-16.
In course of liver cirrhosis, esophageal varices develop with an incidence of 8-15% a year, and they constitute a sign of seriousness of portal hypertension. The risk of bleeding is estimated around 10-15% a year. The varices hemorrhage causes a high rate of mortality (around 30-35% for every hemorrhagic event). It follows that it is necessary to plan prophylactic strategies for all the cirrhotic patients, who are at risk of bleeding, or have already bled. Medical treatment with beta-blockers is indicated in the prophylaxis of the first bleeding, while endoscopic treatment represents now the most effective methodology either in acute bleeding, or in the prophylaxis of hemorrhage relapses. The available endoscopic methodologies are the sclerosis or band ligation of esophageal varices. However, unanimous consent about the greater effectiveness of a methodology compared to the other one doesn't exist. As far as the varices eradication is concerned, the authors have done a research to verify if the combined techniques, proposed in various studies appeared in literature, can have some advantages, in comparison with the single methodologies.
Thirty-seven patients have been treated: 27 only with sclerosis and 10 with combined methodology (band-ligation followed by sclerosis of the small residual varices).
The group treated with the combined therapy have shown a reduction in relapses and in the main side effects and a better patients' compliance.
The combination of the two methodologies can have some advantages as for security, easiness of execution, reduction in complications, in varices relapse and, therefore, in the hemorrhagic relapses.
在肝硬化病程中，食管静脉曲张每年的发生率为8% - 15%，是门静脉高压严重程度的一个标志。每年出血风险估计约为10% - 15%。静脉曲张出血导致的死亡率很高（每次出血事件约为30% - 35%）。因此，有必要为所有有出血风险或已经出血的肝硬化患者制定预防策略。β受体阻滞剂药物治疗适用于首次出血的预防，而内镜治疗目前是急性出血或预防出血复发中最有效的方法。现有的内镜方法是食管静脉曲张硬化术或套扎术。然而，对于一种方法比另一种方法更有效的问题，尚未达成一致意见。就静脉曲张根除而言，作者进行了一项研究，以验证文献中各种研究提出的联合技术与单一方法相比是否具有某些优势。
对37例患者进行了治疗：27例仅接受硬化术治疗，10例接受联合方法治疗（先套扎，然后对残留的小静脉曲张进行硬化）。
接受联合治疗的组显示复发率和主要副作用降低，患者依从性更好。
两种方法的联合在安全性、操作简便性、并发症减少、静脉曲张复发以及出血复发减少方面可能具有一些优势。
