内窥镜下结扎术与硬化术+肝外门脉分流术对于食道静脉曲张出血儿童的处理比较

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本月肝脏学杂志再次载文, 对于内窥镜下结扎术与硬化术+肝外门脉分流术对于食道静脉曲张出血儿童的处理比较. 文章摘要陈述结扎术在对于抢救, 治疗成人因为肝硬化引起的静脉曲张病例很有效, 有很大合并症的硬化术等日渐淘汰; 医生对一组患有曲张的儿童进行了结扎和硬化术的比较, 结果发现, 结扎术在争取时间抢救, 效益, 安全, 复发机会上都比硬化术好, 这则技术应该广泛推广给"肝病医生们"; ******** Hepatology 2002 Sep;36(3):666-72 Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction. Zargar SA, Javid G, Khan BA, Yattoo GN, Shah AH, Gulzar GM, Singh J, Rehman BU, Din Z. Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India. Endoscopic sclerotherapy is an effective treatment for bleeding esophageal varices, but it is associated with significant complications. Endoscopic ligation, a new form of endoscopic treatment for bleeding varices, has been shown to be superior to sclerotherapy in adult patients with cirrhosis. To determine the efficacy and safety of endoscopic sclerotherapy and ligation, the 2 methods were compared in a randomized control trial in 49 children with extrahepatic portal venous obstruction who had proven bleeding from esophageal varices. Twenty-four patients were treated with sclerotherapy and 25 with band ligation. No significant differences were found between the sclerotherapy and ligation groups in arresting active index bleeding (100% each) and achieving variceal eradication (91.7% vs. 96%, P =.61). Band ligation eradicated varices in fewer endoscopic sessions than did sclerotherapy (3.9 +/- 1.1 vs. 6.1 +/- 1.7, respectively, P <.0001). The rebleeding rate was significantly higher in the sclerotherapy group (25% vs. 4%, P =.049), as was the rate of major complications (25% vs. 4%, P =.049). After eradication, esophageal variceal recurrence was not significantly different in patients treated by ligation than by sclerotherapy (17.4% vs. 10%, P =.67). In conclusion, variceal band ligation in children is a safe and effective technique that achieves variceal eradication more quickly, with a lower rebleeding rate and fewer complications compared with sclerotherapy. PMID: 12198659 [PubMed - in process]