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[目的]探讨内镜下静脉曲张套扎同时应用硬化剂夹心法(套扎-硬化-套扎即EVL-EVS-EVL)治疗食管静脉曲张破裂出血的疗效。[方法]对23例肝硬化食管静脉曲张破裂出血的患者采用夹心法治疗,每条曲张静脉结扎皮圈不超过3个,并在2个结扎点之间的曲张静脉内注射l~3ml硬化剂。其中10例在首次内镜治疗时接受食管静脉造影检查。于治疗后2周、1个月、3个月、6个月、12个月胃镜随访,了解静脉曲张变化情况,记录患者不良反应及并发症。[结果]10例行静脉造影检查中7例硬化剂在曲张静脉内滞留时间超过40min。夹心法控制活动性食管静脉曲张出血的止血成功率为100%,静脉曲张消除率为86.9%(20/23),再出血发生率为8.6%(2/23),随访期内静脉曲张复发率为13.0%(3/23)。[结论]夹心法能使硬化剂在曲张静脉内滞留较长时间,在一次治疗后能有效提高静脉曲张消除率,降低再出血率及静脉曲张复发率,是内镜下治疗食管静脉曲张破裂出血的较理想选择。
[Objective] To investigate the efficacy of endoscopic varicose vein ligation combined with sclerotherapy (ligation-sclerotherapy-ligation or EVL-EVS-EVL) for esophageal variceal bleeding. [Method] Twenty-three patients with cirrhosis esophageal variceal bleeding were treated by sandwich method. Each varicose veins was lined with no more than three appendectomies and l ~ 3ml hardener was injected into varicose veins between two ligature points . Ten of them underwent esophageal venography during the first endoscopic treatment. Follow-up was performed at 2 weeks, 1 month, 3 months, 6 months and 12 months after treatment to learn the varicose veins and to record the adverse reactions and complications of the patients. [Results] Seven cases of sclerosing agents in 10 cases of venous angiography were kept in the varicose vein for more than 40 minutes. The success rate of hemostasis in control of active esophageal varices by sandwich method was 100%, the rate of varices was 86.9% (20/23) and the rate of rebleeding was 8.6% (2/23). The recurrence rate of varicose veins 13.0% (3/23). [Conclusion] The sandwich method can make the hardener stay in the varicose vein for a long time. After a single treatment, it can effectively improve the rate of varicose veins, reduce the rate of rebleeding and the recurrence rate of varicose veins. It is an endoscopic treatment of esophageal variceal bleeding The more ideal choice.