Sakai P, Boaventura S, Ishioka S, Mies S, Sette H, Pinotti H W
Department of Gastrointestinal Endoscopy and Digestive Surgery, Hospital das Clínicas de Faculdade de Medicina da Universidade de São Paulo, Brazil.
Endoscopy. 1990 Jan;22(1):5-7. doi: 10.1055/s-2007-1012777.
Ninety-seven patients with bleeding esophageal varices due to mansonic schistosomiasis were treated with endoscopic sclerotherapy. Seventy-five patients (Group I) had previously undergone surgery for portal hypertension and presented with bleeding recurrence. Twenty-two patients (Group II) had not undergone surgical treatment. The sclerotherapy technique employed was intravascular (IV) injections of ethanolamine in 40 patients and paravascular (PV) in 57 patients. Of a total of 38 (39%) patients who had bleeding recurrence, 27 (36%) were from Group I and 11 (50%) from Group II (p less than 0.005). Over a follow-up period of 48 to 132 months, 367 sessions of sclerotherapy were carried out in the 72 remaining patients from Group I (4.93 +/- 2.05). The remaining 16 patients from Group II needed 121 (7.56 +/- 2.70) sessions of sclerotherapy (p less than 0.001). Thus, sclerotherapy was effective in the control of rebleeding in 73 (97.3%) patients from Group I and 16 (72.7%) from Group II (p less than 0.05). We conclude that previous surgical treatment for portal hypertension in patients with mansonic schistosomiasis, greatly benefits treatment of rebleeding esophageal varices by endoscopic sclerotherapy. This is probably due to the lower portal pressure after splenectomy.
97例曼氏血吸虫病所致食管静脉曲张出血患者接受了内镜硬化治疗。75例患者（I组）既往曾接受门静脉高压手术治疗，现出现出血复发。22例患者（II组）未接受过手术治疗。所采用的硬化治疗技术为：40例患者采用血管内（IV）注射乙醇胺，57例患者采用血管旁（PV）注射。在总共38例（39%）出血复发的患者中，27例（36%）来自I组，11例（50%）来自II组（p<0.005）。在48至132个月的随访期内，I组剩余的72例患者进行了367次硬化治疗（4.93±2.05）。II组剩余的16例患者需要121次（7.56±2.70）硬化治疗（p<0.001）。因此，硬化治疗对I组73例（97.3%）患者和II组16例（72.7%）患者的再出血控制有效（p<0.05）。我们得出结论，曼氏血吸虫病患者既往接受门静脉高压手术治疗，对内镜硬化治疗食管静脉曲张再出血有很大益处。这可能是由于脾切除后门静脉压力降低所致。
