Sauerbruch T, Weinzierl M, Ansari H, Paumgartner G
Medical Department II, University of Munich, West Germany.
Endoscopy. 1987 Sep;19(5):181-4. doi: 10.1055/s-2007-1018277.
One-hundred-seventy-five patients with oesophageal variceal bleeding and liver cirrhosis who underwent long-term injection sclerotherapy were prospectively followed for 44 +/- SD 17 months. While aetiology (alcoholic vs. non-alcoholic cirrhosis) had no influence on survival, the Child status assessed at the time of initiation of sclerotherapy was of important prognostic value (mortality rate after a mean follow-up of 44 months: Child A 5%, Child B 45%, and Child C 83%). Initiation of sclerotherapy (elective vs. emergency) had no influence on survival in the A/B patients, whereas electively treated Child C patients had a somewhat better outcome than those in whom sclerotherapy was started during active bleeding. Rebleeding, especially within the first two months after starting repeat sclerotherapy, was significantly influenced by the Child status of the patients. About one-fourth of all deaths were combined with rebleeding in the Child B and C patients, but none of the A patients had intestinal bleeding prior to death. It is concluded that Child A patients have an excellent long-term prognosis after variceal haemorrhage treated by repeated endoscopic injection of the varices.
对175例患有食管静脉曲张出血和肝硬化且接受长期注射硬化疗法的患者进行了前瞻性随访，随访时间为44±标准差17个月。虽然病因（酒精性肝硬化与非酒精性肝硬化）对生存率没有影响，但在开始硬化疗法时评估的Child分级具有重要的预后价值（平均随访44个月后的死亡率：Child A级为5%，Child B级为45%，Child C级为83%）。硬化疗法的起始时机（择期与急诊）对A/B级患者的生存率没有影响，而择期治疗的Child C级患者的预后比在活动性出血期间开始硬化疗法的患者稍好。再出血，尤其是在开始重复硬化疗法后的头两个月内，受患者Child分级的显著影响。在所有死亡病例中，约四分之一的Child B级和C级患者合并再出血，但A级患者在死亡前均无肠道出血。结论是，通过反复内镜下注射曲张静脉治疗静脉曲张出血后，Child A级患者具有良好的长期预后。
