Endoscopic Variceal Ligation for the Treatment of Bleeding Esophageal Varices

食道靜脈瘤結紮術對急性食道靜脈瘤出血療效的評估

陳啓益(Chi-Yi Chen) ； 林勤益(Ching-Yih Lin) ； 張定宗(Ting-Tsung Chang) ； 辛政憲(Jeng-Shiann Shin) ； 陳炯瑜(Chiung-Yu Chen) ； 楊基滐(Chi-Chieh Yang) ； 廖泰政(Tay-Chen Leow) ； 許銘仁(Ming-Juen Sheu) ； 林錫璋(Xi-Zhang Lin)

《中華民國消化系醫學會雜誌》 11卷3期 (1994/09) Pp. 187-193

https://doi.org/10.6557/GJTa.199409_11(3).0002

摘要

內視鏡食道靜脈瘤結紮術(EVL)是一種治療食道靜脈瘤出血的新方法，文獻報告它的療效與硬化治療不相上下，但治療的合併症較少，安全性較高。不過到目前為止，EVL的臨床報告仍然很少。為了評估EVL的止血成效與預後的結果，我們自1993年l月到1994年2月間，進行了這項前瞻性的研究。我們收集了50位經內視鏡診斷為食道靜脈瘤出血的患者，在出血的24小時內，使用Stiegmann結紮器進行結紮止血。26位活動性出血患者23位成功的應用EVL達到止血的目的，止血率是88%。50位患者經EVL治療的病人，47位不再出血順利出院，有2位發生再出血，經第二次EVL後才成功止血，一位患者因治療失敗，出血致死。在14個月的追蹤治療中，35位患者經一系列EVL後，達到食道靜脈瘤根除(70%)，達到食道靜脈瘤根除所須EVL的治療次數是2.6±1.1，所耗的時間是35±13天。所須的EVL結紮次數16.7±8.8，亦即每次EVL約須要6.2±2.1次結紮。其中有11位患者發生再出血(22%)，而有7位因再出血而致死。總共有14位患者死亡，死亡率28%。綜合上述結果，我們認為EVL對急性食道靜脈瘤出血有良好的止血效果，可以很快地完成食道靜脈瘤根除，減少再出血的機會；不失為一種有效的內視鏡療法。

關鍵字

食道靜脈瘤結紮術 ； 食道靜脈瘤出血

並列摘要

Endoscopic variceal ligation is a new form of endoscopic treatment for bleeding esophageal varices. A prospective study was conducted to evaluate the efficacy of endoscopic variceal ligation in cirrhotic patients with bleeding varices. Fifty patients with bleeding esophageal varices received emergent endoscopic variceal ligation. Banding ligation was highly effective in controlling active hemorrhage in 23 of 26 patients (88%). Overall, 14 patients died during the study, only one during the initial course of EVL. Variceal obliteration was achieved in 35 patients (70%). The total number of treatment sessions for variceal eradication was 2.6±1.1, and the time needed to eradicate all varices was 35.6±13.1 days. Total number of rubber bandage used for variceal eradication was 16.7±8.8, and the number at each session was 6.3±2.1. Recurrent bleeding was noted in 11 patients (22%) during the follow-up period. All but three rebleeds occurred after eradication, including two gastric variceal bleeding and one esophageal variceal bleeding. We conclude that endoscopic ligation controls active variceal bleeding effectively and eradicates varices in fewer treatment sessions.

並列關鍵字

endoscopic variceal ligation ； bleeding esophageal varices