关键词: 肝硬化, 食管胃底静脉曲张破裂出血, 内镜下套扎, 硬化剂注射, 组织黏胶注射, 再出血

Abstract: Objective To investigate the clinical efficacy of endoscopic variceal ligation combined with sclerotherapy in the treatment of patients with hepatitis B liver cirrhosis complicated by esophageal and gastric varices bleeding （EGVB）. Methods 120 patients with hepatitis B liver cirrhosis and EGVB between February 2012 and February 2016 were recruited in our hospital. The clinical data of patients were retrospectively analyzed. Esophageal variceal bleeding were treated by endoscopic variceal ligation （EVL） combined with endoscopic variceal sclerotherapy （EIS） and gastric variceal bleeding were treated with endoscopic injection of tissue adhesive combined with EIS treatment. Propranolol was given post-operational. The clinical efficacy and risk factors of rebleeding were analyzed. Results The success rate of hemostasis was 100.0% in our series;the varices disappeared in 90.9% of patients with EGVB types one,significantly higher than 66.7% in with type two or 69.4% in with type one/two;the variceal recurrence rate in EGVB type one was significantly lower than those in patients with type one/two or type two（P<0.05）;after treatment,the rates of rebleeding in patients with different types of varices showed no significant difference（P>0.05）;the proportion of male and aged >65 yr in 35 patients with rebleeding were 85.7% and 31.4%,respectively,significantly higher than 49.4% and 14.1%（P<0.05） in 85 patients without rebleeding,the portal vein diameter and Child-Pugh scores were（1.5±0.5）cm and （10.3±2.1）,respectively,significantly wider or higher than （1.1±0.2） cm and [（7.3±1.3）,respectively,P<0.05] in patients without rebleeding; serum albumin level and serum sodium concentration in rebleeding group were （23.4±5.5） g/L and （124.67±31.47） mmol/L,significantly lower than [（33.6±6.7） g/L and（137.5±36.2） mmol/L,respectively,P<0.05] in patients without rebleeding;Logistic regression analysis showed that the portal vein diameter[OR=3.713 （1.253~10.999）] and Child-Pugh score[OR=4.267（1.311~13.886）] were the independent risk factors for rebleeding after operation,and the blood albumin level [OR=0.236（0.062~0.902）] and sodium concentration [OR=0.143（0.026~0.785）] were the protective factors for rebleeding. Conclusion Endoscopic variceal ligation combined injection of sclerosing agent in the treatment of patients with hepatitis B liver cirrhosis with EGVB can get a good significantly clinical curative efficacy and the best efficacy in patients with EGVB type one. The diameter of portal vein and Child-Pugh score are the independent risk factors in forecasting rebleeding in patients with hepatitis B cirrhosis complicated by EGVB after endoscopic treatment.

Key words: Liver cirrhosis, Esophageal and gastric varices bleeding, Endoscopic variceal ligation, Sclerotherapy, Histoacryl injection, Rebleeding