Kiviniemi H, Mäkelä J, Haukipuro K, Kairaluoma M I
Department of Surgery, Oulu University Hospital, Finland.
Hepatogastroenterology. 1995 Sep-Oct;42(5):546-50.
BACKGROUND/AIM: Severe hemorrhage from oesophageal varices is one of the most serious complications in patients with liver cirrhosis and portal hypertension, affecting about 30-70% of the former. This paper reports the results of treatment of oesophageal varices by injection sclerotherapy.
89 patients with oesophageal varices were treated with sclerotherapy in Oulu University Hospital in the period 1982-1991. The indication was acute bleeding in 74 cases and prophylaxis in 15.
Three patients died of rebleeding before eradication of the varices and nine afterwards. Rebleeding was more common in the Child B and C groups than in Child A (p < 0.01). Rebleeding did not correlate with the amount of sclerosant used. The most common complication was oesophageal stricture, noted in 15 patients, although only two required dilatation. This correlated with the amount of sclerosant used (P < 0.05). 34% of the patients died during the follow-up, the overall mortality rate being 14% in Child A cases, 35% in Child B cases and 92% in Child C cases. Mortality was 26% among the patients receiving prophylactic sclerotherapy (4/15) and 35% among those with bleeding varices 35% (26/74). Five patients were operated on for rebleeding problems, four as emergencies and one electively. Two emergency patients died.
While the number of patients in our group receiving prophylactic sclerotherapy was small, our results follow the general survival trend for bleeding varices.
背景/目的：食管静脉曲张破裂大出血是肝硬化门静脉高压患者最严重的并发症之一，约30%-70%的肝硬化患者会出现该并发症。本文报告了硬化剂注射疗法治疗食管静脉曲张的结果。
1982年至1991年间，奥卢大学医院对89例食管静脉曲张患者采用硬化疗法进行治疗。其中74例为急性出血，15例为预防性治疗。
3例患者在静脉曲张根除前死于再出血，9例在根除后死于再出血。Child B和C组的再出血发生率高于Child A组（p<0.01）。再出血与硬化剂使用量无关。最常见的并发症是食管狭窄，15例患者出现该并发症，其中仅2例需要扩张治疗。这与硬化剂使用量相关（P<0.05）。34%的患者在随访期间死亡，Child A组的总死亡率为14%，Child B组为35%，Child C组为92%。接受预防性硬化治疗的患者死亡率为26%（4/15），静脉曲张出血患者的死亡率为35%（26/74）。5例患者因再出血问题接受手术治疗，4例为急诊手术，1例为择期手术。2例急诊手术患者死亡。
虽然我们组接受预防性硬化治疗的患者数量较少，但我们的结果与静脉曲张出血患者的总体生存趋势一致。
