Hashizume M, Kitano S, Koyanagi N, Tanoue K, Ohta M, Wada H, Yamaga H, Higashi H, Iso Y, Iwanaga T
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Hepatology. 1992 Jan;15(1):69-75. doi: 10.1002/hep.1840150114.
We report here the results of endoscopic injection sclerotherapy performed in 1,000 consecutively treated Japanese patients with esophageal varices. This prospective study covered the period from 1982 to 1990. Variceal bleeding was controlled in 215 (97.7%) of 220 patients. Esophageal varices were completely eradicated in 778 patients (77.8%); the mean number of sessions was 4.2. In only 3 of the 778 patients did esophageal varices of the same size recur. Small, dilated, venous vessels that required additional sclerotherapy in follow-up endoscopy at 3-mo intervals appeared in 171 (22.2%) of 778 patients. The cumulative nonbleeding rate at 5 yr was 94.5% in patients in whom the varices had been eradicated. Deaths caused by upper gastrointestinal bleeding accounted for 2.6% of cases, whereas the rates of liver failure and hepatoma were 4.6% and 47.3%, respectively. The 5-yr cumulative survival rate was 54.1% in patients without concomitant hepatoma; it was 12.0% in patients with hepatomas. Multivariate analysis showed that hepatoma, Child classification, indication (acute, elective or prophylactic) and eradication were independent factors that significantly influenced survival time. This study clearly shows that close follow-up with endoscopy and complete eradication lead to significant reduction in bleeding from esophageal varices and reduction of mortality related to this bleeding.
我们在此报告对1000例连续接受治疗的日本食管静脉曲张患者进行内镜注射硬化疗法的结果。这项前瞻性研究涵盖了1982年至1990年期间。220例患者中有215例（97.7%）的静脉曲张出血得到控制。778例患者（77.8%）的食管静脉曲张被完全根除；平均治疗次数为4.2次。在778例患者中，只有3例出现了相同大小的食管静脉曲张复发。778例患者中有171例（22.2%）出现了小的、扩张的静脉血管，需要在3个月间隔的随访内镜检查中进行额外的硬化治疗。静脉曲张已被根除的患者5年累计无出血率为94.5%。上消化道出血导致的死亡占病例的2.6%，而肝衰竭和肝癌的发生率分别为4.6%和47.3%。无伴发肝癌的患者5年累计生存率为54.1%；有肝癌的患者为12.0%。多变量分析表明，肝癌、Child分级、治疗指征（急性、择期或预防性）和根除是显著影响生存时间的独立因素。这项研究清楚地表明，通过内镜密切随访和完全根除可显著减少食管静脉曲张出血以及与此出血相关的死亡率。
