Ishida M, Masuyama H
Second Department of Internal Medicine, Dokkyo University School of Medicine, Tochigi, Japan.
Gastroenterol Jpn. 1989 Aug;24(4):347-56. doi: 10.1007/BF02774339.
Eighty cases of endoscopic injection sclerotherapy for esophageal varices were retrospectively studied to evaluate their prognoses. These cases were evaluated in terms of post-therapeutic bleeding, survival rates and causes of death. Post-therapeutic bleeding occurred in 50% of the emergency cases (26 cases), 25% of the elective cases (16 cases) and 23.7% of the prophylactic cases (38 cases). The frequency of post-therapeutic bleeding was significantly lower in cases with variceal obliteration than in cases without obliteration. An evaluation of the survival rates by the Kaplan-Meier method revealed that poor prognostic factors in sclerotherapy cases were emergency cases, Child's C group, post-therapeutic cases with unsuccessfully obliterated varices, and cases with post-therapeutic bleeding. Concerning early death within 7 days after sclerotherapy, 4 emergency cases died from initial variceal bleeding despite sclerotherapy. Three of these 4 were hepatocellular carcinoma cases, and all 3 cases had tumor thrombi of the portal vein. We recommend prophylactic sclerotherapy from the standpoint of the prognosis after sclerotherapy. However, in the bleeding cases of hepatocellular carcinoma in Child's C group complicated by tumor thrombi of the portal vein, overly enthusiastic application of the therapy should be avoided.
回顾性研究80例内镜下注射硬化剂治疗食管静脉曲张的病例，以评估其预后。从治疗后出血情况、生存率和死亡原因等方面对这些病例进行评估。治疗后出血发生在50%的急诊病例（26例）、25%的择期病例（16例）和23.7%的预防性病例（38例）中。静脉曲张闭塞的病例治疗后出血频率明显低于未闭塞的病例。采用Kaplan-Meier法评估生存率显示，硬化剂治疗病例的不良预后因素为急诊病例、Child's C组、治疗后静脉曲张未成功闭塞的病例以及治疗后出血的病例。关于硬化剂治疗后7天内的早期死亡，4例急诊病例尽管接受了硬化剂治疗仍死于初始静脉曲张出血。这4例中有3例为肝细胞癌病例，且所有3例均有门静脉肿瘤血栓形成。从硬化剂治疗后的预后角度出发，我们推荐预防性硬化剂治疗。然而，对于Child's C组合并门静脉肿瘤血栓形成的肝细胞癌出血病例，应避免过度积极地应用该治疗方法。
