Esophageal variceal bleeding:comparative results with different therapies
- VernacularTitle:食管静脉曲张破裂出血的四种治疗方法疗效比较
- Author:
Zigang WU
;
Qiusheng ZHANG
;
Huabin QUAN
- Publication Type:Journal Article
- Keywords:
Esophageal variceal hemorrhge;
Rebleeding
- From:
Chinese Journal of Digestive Endoscopy
1996;0(06):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective The therapeutic effect for hemorrhage from esophageal varices(EV)with conservation,surgical intervention,EVL(esophageal variceal ligation)or TIPSS(transvenous intrahepatic portal systemic shunt)were compared.Methods The clinical materials of 72 patients with bleeding from EV were retrospectively reviewed. Results With octreotide(n=23) the rates of hemostasis within 48 hours and hospital mortality maintained 78.3 and 8.7 percent respectively.Rebleeding occurred within 7 days in 3/18 cases(16.7％ ) and within 150 days in 6/18 cases(33.3％ ),resulting in death in 4/18 instances;with emergency surgery death encountered in 4 out of 13 cases(30.8％ ),while with elective operation no death could be traced,7.7 percent of the series with octreotide rebled within 1 year and 19.2 percent did so after 2 years;after EVL(n=8) the varices reduced obviously or eliminated in 75 percent without rebleeding and death in follow-up period of 1～ 33 months;EV disappeared or ameliorated immediately following TIPSS in 9 out of 10 successful cases,yet the rebleeding rate attained 30 and 80 percent within 1 and 5 years respectively.The stent was proved afterwards stenosed or obstructed by ultrasonography.Encephalopathy ensued in 40 percent of the cases with 6 deaths in 61 months. Conclusion It was assumed that octreotide exerted affimative effect in the control of acute bleeding,particularly indicated for patients who were too weak to have endoscopy in 24 hours after admission,however bleeding often recurred following the use;elective surgery might reduce the early rebleeding rate and prolong the interval of rebleeding;EVL was capable of eradicating EV with simplicity;TIPSS had poor long-term effect.
