Lo G H, Lai K H, Cheng J S, Lin C K, Huang J S, Hsu P I, Huang H C, Chiang H T
Division of Gastroenterology, Department of Medicine, Veterans General Hospital-Kaohsiung, National Yang-Ming University, Taipei, Taiwan, Republic of China.
Hepatology. 1998 Aug;28(2):391-5. doi: 10.1002/hep.510280215.
Endoscopic variceal ligation (EVL) is a new technique designed to manage esophageal varices. The effect of sclerotherapy following repeated banding ligation remains unknown. Seventy-two patients with a history of esophageal variceal bleeding received regular EVL until variceal disappearance or until left with residual small varices. Subsequently, patients were randomized to receive sclerotherapy (Group 1, 37 patients) or serve as a control (Group 2, 35 patients). Group 1 received one to two sessions of low-dose sclerotherapy to achieve complete variceal disappearance. After a mean follow-up of 2 years, 4 months, recurrent esophageal varices developed in 14% of Group 1 and 43% of Group 2 (P < .02). Rebleeding was encountered in 8% of Group 1 versus 31% of Group 2 (P = .01). One case of esophageal stricture (2.7%) was encountered in Group 1. One patient in Group 1, compared with 3 patients in Group 2, died of massive variceal bleeding (P > .05). The multivariate Cox model indicated that treatment was the only factor predictive of variceal recurrence, and both Child-Pugh class and treatment were factors predictive of variceal rebleeding. The addition of low-dose sclerotherapy following repeated banding ligations proved safe and effective in the prevention of recurrence of esophageal varices and rebleeding.
内镜下静脉曲张套扎术（EVL）是一种用于治疗食管静脉曲张的新技术。重复套扎后进行硬化治疗的效果尚不清楚。72例有食管静脉曲张出血史的患者接受了定期的EVL治疗，直至静脉曲张消失或仅残留小静脉曲张。随后，患者被随机分为接受硬化治疗组（第1组，37例患者）或作为对照组（第2组，35例患者）。第1组接受1至2次低剂量硬化治疗以实现静脉曲张完全消失。平均随访2年4个月后，第1组14%的患者出现复发性食管静脉曲张，第2组为43%（P<0.02）。第1组8%的患者再次出血，第2组为31%（P = 0.01）。第1组出现1例食管狭窄（2.7%）。第1组有1例患者与第2组的3例患者死于大量静脉曲张出血（P>0.05）。多变量Cox模型表明，治疗是预测静脉曲张复发的唯一因素，而Child-Pugh分级和治疗都是预测静脉曲张再出血的因素。重复套扎后加用低剂量硬化治疗在预防食管静脉曲张复发和再出血方面被证明是安全有效的。
