肖石根

[摘要] 目的 观察口服普萘洛尔或内镜套扎预防肝硬化食管静脉曲张初次出血的效果。 方法 随机选取我院2013年1月～2015年1月收治的48例肝硬化食管静脉曲张患者，根据治疗方法不同进行分组，药物治疗组24例给予患者口服普萘洛尔，内镜套扎组24例定期给予内镜下多环套扎治疗，观察和记录两组患者2年内的再出血发生率、静脉曲张消失率、复发率、并发症发生率。 结果 药物治疗组和内镜套扎组2年内的再出血发生率、静脉曲张消失率、复发率、并发症发生率相当，差异无统计学意义（P>0.05）。 结论 口服普萘洛尔和内镜套扎预防肝硬化食管静脉曲张初次出血均为安全有效的预防措施，其疗效和安全相当。

[关键词] 普萘洛尔；内镜套扎；肝硬化食管静脉曲张；初次出血

[中图分类号] R575.2 [文献标识码] A [文章编号] 2095-0616（2017）07-237-03

Effect observation of oral propranolol or endoscopic variceal ligation in prevention of first bleeding of esophageal varices

XIAO Shigen

Shixing People's Hospital，Shixing 512500，China

[Abstract] Objective To observe the effect of oral propranolol or endoscopic variceal ligation in prevention of first bleeding of esophageal varices. Methods 48 patients with esophageal varices who were admitted to our hospital from January 2013 to January 2015 were randomly selected and they were divided into the medication group and the endoscopic variceal ligation group according to different treatment methods，with 24 in each.The medication group was given oral propranolol while the endoscopic variceal ligation group was given endoscopic variceal ligation regularly for treatment.Incidence of recurrent bleeding，disappearance rate of varices，recurrence rate and incidence of complication within two years of patients in two groups were observed and recorded. Results Incidence of recurrent bleeding，disappearance rate of varices，recurrence rate and incidence of complication within two years of two groups were almost equal and there was no significant difference（P>0.05）. Conclusion Oral propranolol and endoscopic variceal ligation are both safe and effective measures in prevention of first bleeding of esophageal varices.In addition，their curative effect and safety are almost equal.

[Key words] Propranolol；Endoscopic variceal ligation；Esophageal varices；First bleeding

肝硬化食管靜脉曲张初次出血（EGVB）属于临床常见的一种并发症，由肝硬化门脉高压所致，也是该疾病的主要致死原因之一[1]。肝硬化食管静脉曲张的发病率高达30% ～ 60%，肝硬化食管静脉曲张初次出血占所有肝硬化食管静脉曲张患者的比例高达30%～50%[2]。因此，必须对首次出血进行积极的干预，尽量减少出血的风险，这有利于提高患者的生存率，对改善预后情况具有积极的作用[3-4]。内镜套扎治疗是通过套扎设备对曲张静脉进行结扎，从而对曲张静脉血流进行阻断，并且抑制局部缺血坏死、溃疡形成、瘢痕形成等，最终达到预防食管曲张静脉破裂出血的目的。然而高出血风险的肝硬化食管静脉曲张患者应选择何种措施尚处于研究当中，本研究采用口服普萘洛尔、内镜套扎两种方法治疗肝硬化食管静脉曲张初次出血患者，并进行比较，现报道如下。