Karrer F M, Holland R M, Allshouse M J, Lilly J R
Department of Surgery, University of Colorado School of Medicine, Children's Hospital, Denver.
J Pediatr Surg. 1994 Aug;29(8):1149-51. doi: 10.1016/0022-3468(94)90298-4.
Thirty-one endoscopic variceal ligation (EVL) procedures have been done in seven consecutively treated children who had esophageal varices resulting from portal vein thrombosis. Using an elastic band ligature device attached to a standard flexible endoscope, the varices in the distal 5 cm of the esophagus were mechanically strangulated. Typically, one to three varices were banded at each session. The children were between 8 months and 19 years of age at the onset of variceal bleeding. Treatment initially required frequent procedures (every 2 to 4 weeks), but the interval was gradually extended to biannual or annual. Treatment was assessed by survival, complications, incidence of rebleeding, and obliteration of varices. Each patient had from 3 to 9 EVL sessions. There were no deaths related to EVL. There were no complications. Only one patient had rebleeding in the interval between sessions. The follow-up period is 3 to 12 years. In three of the six surviving patients, the varices have been completely eradicated. The remaining three are completing treatment. Endoscopic variceal ligation is safe efficacious treatment for control of variceal bleeding caused by portal vein thrombosis. In our experience, the technique has eliminated the need for portosystemic shunting in this patient population.
对7例因门静脉血栓形成导致食管静脉曲张的连续治疗儿童进行了31次内镜下静脉曲张结扎术（EVL）。使用连接到标准柔性内窥镜的弹性带结扎装置，对食管远端5 cm内的静脉曲张进行机械勒扎。通常，每次手术结扎1至3个静脉曲张。静脉曲张出血开始时，这些儿童年龄在8个月至19岁之间。治疗初期需要频繁手术（每2至4周一次），但间隔时间逐渐延长至半年或一年。通过生存率、并发症、再出血发生率和静脉曲张闭塞情况对治疗进行评估。每位患者接受了3至9次EVL手术。没有与EVL相关的死亡病例。没有并发症。只有1例患者在手术间隔期出现再出血。随访期为3至12年。在6例存活患者中的3例中，静脉曲张已完全消除。其余3例正在完成治疗。内镜下静脉曲张结扎术是控制门静脉血栓形成所致静脉曲张出血的一种安全有效的治疗方法。根据我们的经验，该技术已使这一患者群体无需进行门体分流术。
