Stiegmann G V, Goff J S, Sun J H, Davis D, Silas D
Department of Surgery (Gastrointestinal/Tumor), University of Colorado, Denver.
Surg Endosc. 1989;3(2):73-8. doi: 10.1007/BF00590904.
Endoscopic variceal ligation (EVL) is a new technique designed to be used instead of sclerotherapy. Small elastic "O" rings ligate varices resulting in their strangulation and eradication. During a 12-month period, EVL was employed in 53 consecutive patients, of whom 36 (68%) had alcoholic cirrhosis 17 were Child-Pugh class A, 22 class B, and 14 class C. Varices were graded from I to IV and repeat treatments were given at 1-2 week intervals until the varices were eliminated. At follow-up ranging from 6-18 months (mean 11.5), 217 EVL treatment sessions had been performed. Of the 13 patients (24%) who died during the study, 11 died during the index hospitalization. Active bleeding was controlled in 19 of 21 patients (90%). Of 40 survivors 13 patients (33%) had 1-2 (mean 1.4) recurrent variceal bleeds while 34 patients had repeat EVL treatment. Elimination of distal varices was achieved in 26 and 7 had reduction of varices from grade III-IV to grade I-II or less. Eradication required a mean of 4.4 EVL sessions in Child's A and B patients and 7.0 sessions in Child's C patients (P less than 0.025). No significant treatment-related complications were observed. EVL appears to control active bleeding, is associated with a low incidence of non-bleeding complications, and may be used as an alternative to sclerotherapy.
内镜下静脉曲张套扎术（EVL）是一种设计用于替代硬化疗法的新技术。小的弹性“O”形环结扎静脉曲张，导致其绞窄和消除。在12个月期间，对53例连续患者采用了EVL，其中36例（68%）患有酒精性肝硬化，17例为Child-Pugh A级，22例为B级，14例为C级。静脉曲张分级为I至IV级，并每隔1 - 2周进行重复治疗，直到静脉曲张消除。在6 - 18个月（平均11.5个月）的随访中，共进行了217次EVL治疗。在研究期间死亡的13例患者（24%）中，11例在首次住院期间死亡。21例患者中有19例（90%）的活动性出血得到控制。在40名幸存者中，13例患者（33%）有1 - 2次（平均1.4次）静脉曲张复发出血，34例患者接受了重复EVL治疗。26例患者的远端静脉曲张消除，7例患者的静脉曲张从III - IV级降至I - II级或更低。Child's A级和B级患者根除静脉曲张平均需要4.4次EVL治疗，Child's C级患者需要7.0次治疗（P小于0.025）。未观察到明显的与治疗相关的并发症。EVL似乎能控制活动性出血，非出血性并发症发生率低，可作为硬化疗法的替代方法。
