Akahoshi Tomohiko, Tomikawa Morimasa, Tsutsumi Norifumi, Hashizume Makoto, Maehara Yoshihiko
Departments of Surgery and Science, Kyushu University, Fukuoka, Japan; Departments of Disaster and Emergency Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Dig Endosc. 2014 Mar;26(2):172-7. doi: 10.1111/den.12119. Epub 2013 May 8.
Several clinical studies of prophylactic therapy for esophageal varices have led to the conclusion that prophylactic therapy is of no value, and it is generally not accepted in the Western world. However, this is not the case in Japan. The present study evaluated the efficacy of prophylactic endoscopic injection sclerotherapy (EIS) in patients with unresectable hepatocellular carcinoma (HCC) and risky esophageal varices.
Twenty-seven patients with 'likely-to-bleed' esophageal varices concomitant with unresectable HCC were randomly allocated to two groups. Thirteen patients underwent prophylactic EIS (EIS group), whereas the remaining 14 patients were observed conservatively (control group).
No bleeding from esophageal varices occurred in the EIS group during the entire period of this study, whereas in thecontrol group the cumulative bleeding rate was 44.8% in 6 months. Cumulative survival rates of patients in the EIS group and in the control group were 48.8% and 7.7% in 2 years, respectively. There was a statistically significant difference between the two groups in cumulative bleeding rate and survival rate (P < 0.01).
This prospective study demonstrated that prophylactic EIS could prolong the survival of the patients with esophageal varices concomitant with unresectable HCC. Prophylactic EIS for patients with unresectable HCC may be, in part, justified according to the present study.
多项关于食管静脉曲张预防性治疗的临床研究得出结论，预防性治疗并无价值，在西方世界通常不被接受。然而，在日本情况并非如此。本研究评估了预防性内镜注射硬化疗法（EIS）对无法切除的肝细胞癌（HCC）合并高危食管静脉曲张患者的疗效。
27例伴有无法切除的HCC且食管静脉曲张“有出血可能”的患者被随机分为两组。13例患者接受预防性EIS（EIS组），其余14例患者进行保守观察（对照组）。
在本研究的整个期间，EIS组未发生食管静脉曲张出血，而对照组6个月时的累积出血率为44.8%。EIS组和对照组患者的2年累积生存率分别为48.8%和7.7%。两组在累积出血率和生存率方面存在统计学显著差异（P < 0.01）。
这项前瞻性研究表明，预防性EIS可延长无法切除的HCC合并食管静脉曲张患者的生存期。根据本研究，对无法切除的HCC患者进行预防性EIS在一定程度上可能是合理的。
