关键词: 肝硬化, 食管静脉曲张, 出血, 序贯治疗

Abstract: Objective To investigate the effect of different sequential therapy on the treatment of esophageal varices bleeding (EVB) in patients with liver cirrhosis on secondary prophylaxis. Methods Data of 62 cases with a clear diagnosis of cirrhosis complicated with EVB (endoscopic grading was severe) and undergone endoscopic treatment were collected, and the patients were randomly divided into three groups:ligation sequential for ligation group (22 cases), sclerotherapy sequential for sclerotherapy group (10 cases), ligation sequential for sclerosing agent group (30 cases). Different pathologic distribution in three different treatments was not significantly different (P>0.05). More than 1 years of follow-up, and death within less than 1 year, rebleeding after operation and loss to follow-up were the end points of the operation in the retrospective analysis. Detailed records were made for all cases with related complications, 5 days of treatment failure rate, 6 weeks mortality, the rate of rebleeding of 1 year, the average days of stay in hospital and the cost of hospitalization. Results (1) The comparison of number of cases with complications between ligation sequential for ligation group, sclerotherapy sequential for sclerotherapy and ligation sequential for sclerosing group demonstrated that the number of esophageal stenosis and infection in sclerotherapy sequential for sclerotherapy was more than that of the other two groups, with a significant difference (P<0.05). (2) There was no significant difference (P>0.05) among the three sequential ways in failure rate 5 days post-treatment and the mortality rate six weeks post-treatment. But the rate of rebleeding one year post-treatment, the effect of ligation sequential for sclerosing group was quite good, there was no rebleeding. While the the rebleeding rates were higher than the other two groups (ligation sequential for ligation group, sclerotherapy sequential for sclerotherapy group). (3) As to the average length of be hospitalization and the costs, the ligation sequential for sclerosing group had relatively short hospital stays and lower costs. Conclusion Endoscopic sequential treatment is an important method of treatment for EVB. The failure rate 5 days post-treatment and the mortality rate six weeks post-treatment of ligation sequential for sclerosing group were lower, compared to the other two sequential treatment modalities. But it has more advantages on the rate of rebleeding one year post-treatment and in medical resources and saving cost.

Key words: liver cirrhosis, esophageal varices, bleeding, sequential therapy