【摘要】 目的评价断流术与内镜硬化剂注射治疗食管静脉曲张破裂出血的安全性与近远期疗效。方法对2007年1月至2016年12月间916例肝硬化门静脉高压症食管静脉曲张破裂出血病人的临床资料进行回顾性分析,其中断流术394例(手术组),内镜治疗522例(内镜组),比较两组术后并发症及预后,术后总体生存率与无复发出血生存率,影响总体生存与无复发出血生存的独立风险因素,术后生存质量。结果手术组肝功能Child-Pugh分级显著好于内镜组,内镜组急诊止血治疗病例显著多于手术组(P<0.05)。断流术相关发症主要为感染、出血、食管吻合口瘘、发热、门静脉系统血栓。内镜治疗相关并发症主要为胸骨后疼痛和进食哽噎感。手术立时止血率为100%,内镜治疗立时止血率为94.1%(P=0.082)。术后1、3、5年总体生存率手术组为93.9%、86.0%、86.0%,内镜组为78.9%、58.7%、30.0%,两组差异有统计学意义(P=0.032)。术后1、3、5年无复发出血生存率手术组为74.9%、74.9%、65.0%,内镜组为65.1%、33.9%、4.9%,两组差异有统计学意义(P=0.028)。手术方式、Child-Pugh分级与终末期肝病模型(model for end-stage liver disease,MELD)评分是影响总体生存的独立危险因素,手术方式为影响无复发出血生存的独立危险因素。手术组在一般健康状况、活力、社会功能、情绪角色功能和心理健康5个维度方面均显著优于内镜组(P<0.05)。结论断流术和内镜硬化剂注射均是止血效果确切的治疗手段,内镜治疗对肝储备功能要求低于断流术,从无复发出血率及远期生存质量角度分析,断流术总体效果优于内镜治疗。更多还原

【Abstract】 Objective To evaluate the safety and short and long-term effectiveness of devascularization vs.endoscopic sclerotherapy in the treatment of esophageal variceal bleeding.MethodsFrom January 2007 to December 2016,916 cases of esophageal variceal bleeding were selected.394 patients underwent devascularization(operation group),and 522 were given endoscopic sclerotherapy(endoscopy group).The postoperative complications,overall and recurrence free survival rate,independent risk factor for overall and recurrence free survival and quality of life after surgery were analyzed.Results The liver function in the operation group was better than in the endoscopy group,and the emergency cases in the endoscopy group were significantly more than those in the operation group(P<0.05).The major complications in the operation group included infection,bleeding,anastomotic fistula of esophagus,fever,and thrombosis of the portal vein.The major complications in the endoscopy group were chest pain and choking.The rate of hemostasis at the time in the operation and endoscopy groups was 100%and 94.1%respectively(P=0.082).The 1-,3-and 5-year overall survival rate in the operation group was 93.9%,86.0% and 86.0%,and that in the endoscopy group was78.9%,58.7% and30.0%(P=0.032).The 1-,3-and 5-year no recurrent survival rate in the operation group was 74.9%,74.9% and 65.0%,and that in endoscopy group was 65.1%,33.9% and4.9%(P=0.028).Operative methods,Child-Pugh classification and MELD score were independent risk factors for overall survival.Operative methods were independent risk factors affecting survival without recurrence.The operation group was significantly superior to the endoscopy group in 5 dimensions of general health,vitality,social function,emotional role function and mental health(P<0.05).Conclusions Both devascularization and endoscopic sclerotherapy are effective treatments for esophageal variceal bleeding.The liver reserve function of endoscopic treatment is lower than that of devascularization.From the perspective of no recurrent bleeding treatment and long-term quality of life,that overall efficacy of devascularization is superior to endoscopy.更多还原