Cheng C Y, Chen G H, Chang C S, Tseng C C, Pan H K, Huang C K, Hsieh P F
Department of Internal Medicine, Chung Shan Medical and Dental College Hospital, Taichung, Taiwan.
J Gastroenterol. 1994 Aug;29(4):474-8. doi: 10.1007/BF02361246.
Between August 1983 and December 1991 at the Taichung Veterans General Hospital, Taiwan, 65 advanced hepatocellular carcinoma (HCC) patients with esophageal variceal bleeding received endoscopic injection sclerotherapy (EIS) and 60 such patients received conservative medical treatment without EIS. The rate of successful control of acute bleeding was 72.5% (27/40 patients) in the EIS group and 56.7% (34/60 patients) in the non-EIS group. The rebleeding rate was lower in the EIS group than in the non-EIS group (26.9% vs 73.5%). Thirty-one of the EIS and 44 of the non-EIS treatment patients, mainly Child's B and C patients, died within 2 months after the first bleeding. In the short term, EIS decreased the mortality due to esophageal variceal bleeding, but the survivors still had to face hepatic failure and tumor growth. Thus, benefits of EIS were noted on short- but not on long-term survival. The mean survival times were 2.38 months for the EIS group and 1.79 months for the non-EIS group. Since EIS had no beneficial effects on long-term survival it is doubtful whether sclerotherapy applied to esophageal variceal bleeding in patients with advanced HCC would be worthwhile, as the endoscopic procedure would only add to their suffering.
1983年8月至1991年12月期间，在台湾台中荣民总医院，65例晚期肝细胞癌（HCC）合并食管静脉曲张出血的患者接受了内镜注射硬化疗法（EIS），另有60例此类患者接受了不进行EIS的保守药物治疗。EIS组急性出血的成功控制率为72.5%（40例患者中的27例），非EIS组为56.7%（60例患者中的34例）。EIS组的再出血率低于非EIS组（26.9%对73.5%）。EIS治疗的31例患者和非EIS治疗的44例患者（主要是Child's B级和C级患者）在首次出血后2个月内死亡。短期内，EIS降低了食管静脉曲张出血导致的死亡率，但幸存者仍不得不面对肝衰竭和肿瘤生长。因此，EIS在短期生存方面有效果，但对长期生存无效果。EIS组的平均生存时间为2.38个月，非EIS组为1.79个月。由于EIS对长期生存没有有益影响，对于晚期HCC患者的食管静脉曲张出血应用硬化疗法是否值得存疑，因为内镜操作只会增加他们的痛苦。
