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Equal efficacy of endoscopic variceal ligation and propranolol in preventing variceal bleeding in patients with noncirrhotic portal hypertension.
内镜静脉曲张结扎术和普萘洛尔在预防非肝硬化门脉高压患者静脉曲张出血方面的同等疗效。

摘要

BACKGROUND & AIMS:Variceal bleeding increases morbidity and mortality among patients with noncirrhotic portal hypertension (NCPH). Blockers of β-adrenergic receptor signaling and endoscopic variceal ligation (EVL) have been used to prevent recurrence of bleeding, based on data from cirrhotic patients. We compared the efficacy and safety of the β-blocker propranolol with that of EVL in preventing the recurrence of variceal bleeding in patients with NCPH.
METHODS:Consecutive patients with NCPH with a history of variceal bleeding in the past 6 weeks were assigned randomly to groups treated every 3 weeks with EVL (n = 51) or propranolol (until they had a resting heart rate of 55 beats per minute or to a maximum of 320 mg/day; n = 50). Primary end points were recurrence of variceal bleeding or death. Secondary end points were complications of EVL in patients given EVL, variceal eradication after EVL, variceal recurrence after EVL, or a decrease in variceal grade in patients given propranolol.
RESULTS:After a median follow-up period of 23 months, rates of recurrence of bleeding were similar between the groups (EVL, 23.5%; propranolol, 18%; P = .625). The actuarial probability of remaining free of bleeding recurrence was similar between the groups. No deaths occurred in either group. Of the patients given propranolol, 47% had a decrease in the grade of varices and none experienced bleeding. Adverse events were minor and comparable between groups (EVL, 12%; propranolol, 18%; P = .635).
CONCLUSIONS:EVL was not more effective than the β-blocker propranolol for the secondary prophylaxis of variceal bleeding in patients with NCPH.

译文

背景与目的: 静脉曲张出血增加了非肝硬化门脉高压症 (NCPH) 患者的发病率和死亡率。基于肝硬化患者的数据,β-肾上腺素能受体信号的阻滞剂和内镜静脉曲张结扎术 (EVL) 已被用于预防出血复发。我们比较了 β-受体阻滞剂普萘洛尔和 EVL 在预防 NCPH 患者静脉曲张出血复发方面的疗效和安全性。
方法: 过去 6 周有静脉曲张出血史的连续 NCPH 患者被随机分配到每 3 周接受 EVL 治疗的组 (n = 51) 或者普萘洛尔 (直到他们的静息心率达到每分钟 55 次或最高 320 毫克/天; n = 50)。主要终点是静脉曲张出血或死亡的复发。次要终点是 EVL 患者的 EVL 并发症、 EVL 后静脉曲张根除、 EVL 后静脉曲张复发或普萘洛尔患者静脉曲张级别降低。
结果: 在 23 个月的中位随访期后,两组之间出血复发率相似 (EVL,23.5%; 普萘洛尔,18%; P =.625)。两组间无出血复发的精算概率相似。两组都没有死亡。在服用普萘洛尔的患者中,47% 的患者的静脉曲张级别有所下降,没有患者出现出血。不良事件较小,组间具有可比性 (EVL,12%; 普萘洛尔,18%; P =.635)。
结论: EVL 对 NCPH 患者静脉曲张出血的二级预防并不比 β 受体阻滞剂普萘洛尔更有效。

Endoscopic Variceal Ligation

消化 食管静脉曲张破裂出血止血 手术操作
概述  :  

内镜下曲张静脉套扎术(endoscopic variceal ligation,EVL)是基于20世纪50年代的痔疮套扎术的技术演变而来的一种安全、有效、简单的食管静脉曲张破裂出血止血和预防出血的治疗方法,EVL后死亡率更少,再出血率更低,根除曲张静脉更快,副作用更少,被认为是应对食管静脉曲张破裂出血的一项重要内镜处置手段。 原理1)机械中断病变静脉血流,使静脉萎缩,食管局部痉挛;2)被套扎的静脉内血流停止形成血栓并逐渐机化;3)静脉管壁形成瘢痕和纤维化;4)最终曲张静脉退化,达到

endoscopic  [,ɛndəs'kɑpɪk]

释义   adj. 内窥镜的;用内窥镜检查的

例句   Objective: To discuss gastrointestinal polyp typing and endoscopic therapy for "small polyp" . 目的:讨论消化道息肉的分型与“小型息肉”内镜治疗。

 

variceal  [,værɪ'siəl]

释义   adj. (医)静脉曲张的,脉管曲张的

例句   Objective:To analyse the influence of different agents to esophageal variceal bleeding and portal hypertension. 目的:研究不同因素对门脉高压食管胃静脉曲张出血转归的影响。。

 

ligation  [laɪˈɡeɪʃn]

释义   n. 结扎

例句   The rat of portal branch ligation may regard as a model animal of liver regeneration for research. 大鼠门静脉分支结扎可以作为研究肝脏再生动物模型的方法。


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