摘要
目的 探讨川芎嗪联合内镜下曲张静脉套扎术 (EVL)预防肝硬化食管静脉曲张破裂再出血的疗效。方法 对 45例联合治疗组 (EVL联合口服川芎嗪 )和 41例对照组 (单用EVL)患者进行前瞻性对照研究 ,治疗后随访 2年观察两组食管静脉曲线破裂再出血率和病死率 ,两组治疗前后门脉高压性胃病 (PHG)的发生情况 ,并用彩色多普勒超声仪检测门静脉系统血流动力学的变化。结果 随访 2年 ,对照组再出血率显著高于联合治疗组 ,分别为 48.8%和 2 2 .2 % ,病死率也高于联合治疗组 ,分别为 39%和 2 0 % ,两组中ChildC级患者的再出血率和病死率无显著差异。曲张静脉经治疗闭塞后 ,在对照组PHG的发生明显增加 ,而联合治疗组则不然。用川芎嗪 4周后门静脉血流量、脾静脉血流量、门静脉内径和脾静脉内径分别下降 ( 114 6 .2± 391.2 )ml/min、( 5 31.1± 32 1.2 )ml/min、( 1.4± 0 .3)cm及 ( 1.0± 0 .2 )cm ,与用药前相比有显著差异 ,临床上未见明显不良反应。结论 川芎嗪联合EVL可有效预防食管静脉破裂出血 ,并能减少门脉高压性胃病的发生率 ,这是一种安全有效的治疗方法 ,可供临床推广应用。
Objective To investigate the efficacy of Ligustrazine combined with endoscopic variceal ligation (EVL) on prevention of rebleeding of esophageal varices in patients with liver cirrhosis. Methods In this prospective study, 86 patients enrolled were divided into two groups: control group including 41 patients received EVL only and therapeutic group including 45 patients received EVL combined with Ligustrazine. During the two year follow up, the rate of rebleeding and mortality were compared, and emergence of portal hypertensive gastropathy (PHG) evaluated. The portal hemodynamics were also assessed using colored Doppler ultrasound.Results The rate of rebleeding and mortality in the control group were higher as compared with the therapeutic group (48.8% vs 22.2%; and 39% vs 20% respectively, P <0.05). The rate of rebleeding and mortality were not significantly different in the two groups with Child grade C. After ligation of varices, PHG became obvious in the control group ( P <0.01) whereas in the therapeutic group, 4 weeks after the administration of Ligustrazine, the flow and the diameter of portal vein and splenic vein decreased significantly from 1146.2±391.2ml/min to 531.3±321.2ml/min and from 1.4±0.3cm to 1.0±0.2cm, respectively. No adverse effect was found clinically.Conclusion Ligustrazine together with EVL is safe and effective in preventing rebleeding of esophageal varices, with decreased frequency of PHG. Hence, it is worthwhile for wider practice.
出处
《肝脏》
2002年第1期5-7,共3页
Chinese Hepatology
