【摘要】 目的对比研究腔内外联合断流术与内镜下食管曲张静脉套扎术治疗食管曲张静脉的疗效及其对门静脉压力、血流动力学的影响。方法将167例食管曲张静脉患者按分层随机原则分为两组:联合断流术组(82例)和内镜下套扎术组(85例),比较治疗前后两组患者的治疗效果、门静脉压力、血流动力学。结果腔内外联合断流术后穿静脉显示率明显低于术前,明显低于内镜下食管曲张静脉套扎术(EVL)术后,而EVL术后下降不明显;两组患者术后食管曲张静脉分级与术前比较均有较大改善,但术后两组间比较,差异无显著性;两组患者术后食管周围曲张静脉与术前比较均有较大改善,腔内外联合断流术后明显好于EVL术后。两种治疗方式均无患者死亡,主要并发症包括感染、腹内出血、门静脉血栓和肝功能衰竭,两组比较差异无显著性。随访3年,联合断流术组复发率、再出血率、死亡率均低于内镜下套扎术组。术后两组患者门静脉压力、最大血流速度和门静脉血流量较术前均显著下降,而且联合断流术组下降幅度大于内镜下套扎术组。结论腔内外联合断流术比内镜下食管曲张静脉套扎术能更好地治疗食管曲张静脉,降低门静脉压力,改善血流动力学。更多还原

【Abstract】 [Objective] To compare the effects of endoscopic variceal ligation(EVL) and EVL combined with devascularization procedure in the treatment of esophageal varices and its effects on the portal vein pressure,hemodynamic effects.[Methods] One hundred and sixty-seven patients with esophageal varices were randomized into 2 groups:EVL combined with devascularization group(82 cases) and endoscopic ligation group(n=85) were compared before and after treatment in terms of treatment effects,hemodynamics,portal vein pressure.[Results] The perforating veins display rate after EVL combined with devascularization was significantly lower than the preoperative,postoperative and was significantly lower than that of EVL,EVL postoperative decrease;The two groups of patients with esophageal varices classification and comparison of preoperative were greatly improved,but after operation there was no significant difference between the two groups;the two groups of patients with esophageal varicose compared with the preoperative were greatly improved,the EVL combined with devascularization was significantly better in patients after EVL.There was no death in both groups,major complications include infection,intra-abdominal hemorrhage,portal vein thrombosis and liver failure,the difference between the two groups was not obvious.Follow up of 3 years,the recurrence rate,the rate of rebreeding and the mortality rate of the EVL combined with devascularization group were lower than those of EVL group.The postoperative portal venous pressure,maximum blood flow velocity and portal blood flow compared with preoperative decreased significantly,and the EVL combined with devascularization group declined more than the EVL group.[Conclusions] EVL combined with devascularization can better reduce portal pressure and improve hemodynamics than endoscopic esophageal variceal ligation in treating esophageal varices.更多还原