【摘要】：目的探討食管鏡下食管靜脈曲張?zhí)自g(shù)(EVL)治療肝硬化食管靜脈曲張的療效。方法食管靜脈曲張患者56例,其中急性食管靜脈出血32例;無臨床癥狀者24例,均為中重度食管靜脈曲張,為一二級(jí)預(yù)防者。56例均行EVL,術(shù)后4~6周評(píng)價(jià)療效,觀察術(shù)后并發(fā)癥發(fā)生情況。結(jié)果急性出血32例中止血成功31例(96.87%),72 h內(nèi)止血失敗1例(3.12%),術(shù)后72 h~6周4例(12.5%)出血復(fù)發(fā);24例無臨床癥狀者未發(fā)生靜脈破裂出血。術(shù)后4~6周50例獲得隨訪,復(fù)查胃鏡,靜脈曲張根除35例(70%),基本消失15例(30%)。56例中,2例術(shù)后3 d出血復(fù)發(fā),其中急性食管靜脈曲張出血患者1例,重度靜脈曲張一級(jí)預(yù)防者1例,經(jīng)及時(shí)擴(kuò)容、制酸、降門脈壓等藥物治療后好轉(zhuǎn),后再次行EVL止血。術(shù)后出現(xiàn)胸骨后疼痛12例,吞咽困難5例,惡心不適4例,發(fā)熱5例,未做特殊處理,自行緩解。無術(shù)后食管穿孔、狹窄者。結(jié)論 EVL治療肝硬化食管靜脈曲張療效較好。術(shù)中規(guī)范操作、加強(qiáng)圍術(shù)期管理可提高手術(shù)效果并減少并發(fā)癥。
[Abstract]:Objective to evaluate the efficacy of esophageal variceal ligation (EVL) under esophagoscope in the treatment of esophageal varices due to cirrhosis. Methods Fifty-six patients with esophageal varices, including 32 patients with acute esophageal vein hemorrhage, 24 patients with moderate and severe esophageal varices without clinical symptoms, and 56 patients with grade one and two grade prophylaxis, were treated with EVL.Therapeutic effects were evaluated 4 weeks after operation. The incidence of postoperative complications was observed. Results among 32 cases of acute hemorrhage, 31 cases (96.87%) were successful in hemostasis and 1 case (3.12%) failed in hemostasis within 72 hours. 50 cases were followed up 4 weeks 6 weeks after operation, 35 cases (70%) were eradicated by gastroscopy, 15 cases (30%) were basically disappeared, 2 cases had recurrent bleeding 3 days after operation, including 1 case of acute esophageal variceal hemorrhage and 1 case of primary prevention of severe varicose vein. After timely dilatation, acidmaking, reducing portal pulse pressure and other drugs after the improvement, and then EVL hemostasis. Postoperative poststernal pain occurred in 12 cases, dysphagia in 5 cases, nausea and discomfort in 4 cases, fever in 5 cases. No postoperative perforation of esophagus, stenosis. Conclusion EVL is effective in the treatment of esophageal varices due to cirrhosis. Standard operation during operation and strengthening perioperative management can improve the effect of operation and reduce complications.
【作者單位】： 衡陽市第一人民醫(yī)院;
【分類號(hào)】：R575.2

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