套扎與硬化劑比較治療肝硬化食管靜脈曲張出血的中文隨機試驗的系統評價_《中國循證醫學雜志》

作者：

鐘利春 ¹ ,  賈紅 ² , 李昌平 ¹ , 歐三桃 ³ , 彭燕 ¹

1. 瀘州醫學院消化內科（瀘州 646000）2. 瀘州醫學院公共衛生學院3. 瀘州醫學院腎病內科;

關鍵詞：

套扎治療硬化劑治療食管靜脈曲張出血系統評價隨機對照試驗

視頻：

導出 下載 收藏 掃碼 引用

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目的　系統評價國內有關套扎治療與硬化劑治療肝硬化食管靜脈曲張出血的有效性和安全性。
方法　計算機檢索CBMdisc（1979～2006）和CNKI（1994～2006），收集有關套扎與硬化劑比較治療肝硬化食管靜脈曲張出血的隨機對照試驗（RCT）和半隨機對照試驗（CCT），由兩名評價員獨立對納入文獻進行質量評價和數據提取，并使用RevMan4.2.7軟件進行Meta分析。
結果　共納入9個RCT，包括1 371例患者，其中套扎組688例，硬化劑組683例。Meta分析結果顯示：對于死亡率，兩組間差異有統計學意義[RR=0.60，95%CI（0.36，0.98）]，套扎治療組低于硬化劑治療組；對于急診止血率、出血復發率和并發癥發生率，套扎治療組也顯示出更好的療效趨勢；而對于曲張靜脈消失率和曲張靜脈復發率，硬化劑治療組則顯示出更好的療效趨勢。
結論　在治療肝硬化食管靜脈曲張出血患者時，套扎較硬化劑治療顯示出更好的療效及更少的并發癥。但由于納入研究質量不高，這一結論的強度受到一定的限制，尚需今后開展高質量隨機對照試驗來進一步驗證。

引用本文： 鐘利春,賈紅,李昌平,歐三桃,彭燕. 套扎與硬化劑比較治療肝硬化食管靜脈曲張出血的中文隨機試驗的系統評價. 中國循證醫學雜志, 2007, 07(2): 135-141. doi: 復制

1.	Liu HY. Internal medicine.6th ed. Beijing: The people health publishing house, 2004: 440.
2.	Pan GZ, Cao SZ. Contemporary gastroenterology. Beijing: Science publishing house, 1994: 1515.
3.	Liang XY, Zhou WH. Evidence based medicine and hepatopathy clinical practice. Modern Practical Medicine, 2005, 17(2): 119-121.
4.	Li BQ, Zhang XJ, Ma LX, et al. A comparative study of esophageal varicosis treated by sclerotherapy or ligation and combination of ligation and sclerotherapy. Hebei Medical Journal, 2006, 28(10): 914-915.
5.	Liu DL, Huo JR, Wu XP, et al. Comparative Clinical Study of Ligation Versus Sclerotherapy in the Treatment of Bleeding Esophageal Varices. HUNAN MEDICAL JOURNAL, 1999, 16(2): 90-92.
6.	Liu YF, Sun YJ. A cinical study of endoscopic treatment methods in 99 cases of esophageal varices. Journal of Medical Science Yanbian University, 2003, 26(3): 193-196.
7.	Qiu XD, Gu GM, Shi JP, et al. Comparative Study of Endoscopic Variceal Ligation and Endoscopic Sclerotherapy in Treat- ment of Variceal Hemorrhage. Chinese Journal of Gastroenterology, 2000, 5(4): 226-228.
8.	Wang H, Li YY, Nie YQ, et al. Comparison of variceal band ligation with sclerotherapy for control of esophageal varices bleeding. Guangdong Medical Journal, 2002, 23(4): 370-372.
9.	Yang YL, Wang BM, Liu WT, et al. Emergent endoscopic therapy for esophageal and gastric variceal bleeding of hepatic cirrhosis. Clinical Focus, 2006, 21(12): 845-846.
10.	Zeng SQ, Lv RF, Zhao YK, et al. A comparative observation of esophageal varicosis treated by ligation, sclerotherapy or its combination. Journal of Southeast China Mational Defence Medical Science, 2006, 8(2): 99-101.
11.	Zhang YP, Li M. To investigate the clinical result of sclerotherapy, banding ligationand sclerotherapy plus banding ligation sequential treatment in severe as ophagealvaricealbleeding. Journal of Anhui Health Vocational & Technical College, 2004, 3(6): 35-36, 89.
12.	Zhou PH, Yao LQ, Gao WD, et al. Endoscopic therapy for the esophageal variceal bleeding. China Journal of Endoscopy, 2001,7(2): 14-17.
13.	Fan TY, Liu FC. Comparison between effects of ligation and sclerotherapy in treatment of esophageal variceal bleeding after liver cirrhosis:a meta-analysis. World Chinese Journal of Digestology, 2006, 14(17): 1704-1709.
14.	劉厚鈺. 內科學. 第6版. 北京: 人民衛生出版社, 2004: 440.
15.	潘國宗, 曹世植. 現代胃腸病學. 北京: 科學出版社, 1994: 1515.
16.	Schepis F, Camma C, Niceforo D, et al. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatology, 2001, 33(2):333-338.
17.	Sarin SK, Lamba GS, Kumar M, et al. Comparison of endoscopic ligation and propranolol for the primary prevention of variceal bleeding. N Engl J Med, 1999, 340(13): 988-993.
18.	梁曉岳, 周文紅. 循證醫學與肝病臨床實踐. 現代實用醫學, 2005, 17(2): 119-121.
19.	李炳慶, 張學軍, 馬立新, 等. 內鏡下硬化治療、套扎及硬化治療加套扎治療食管靜脈曲張出血的對照研究. 河北醫藥, 2006, 28(10): 914-915.
20.	劉德良, 霍繼榮, 吳小平, 等. 套扎與硬化治療食管靜脈曲張出血的臨床對比研究. 湖南醫學, 1999, 16(2): 90-92.
21.	劉憶非, 孫遠杰. 內窺鏡直視下止血治療食道靜脈曲張出血——附99例報告. 延邊大學醫學學報, 2003, 26(3): 193-196.
22.	邱夏地, 顧國妹, 施建平, 等. 內鏡套扎術和硬化療法治療食管靜脈曲張破裂出血的比較研究. 胃腸病學, 2000, 5(4): 226-228.
23.	王紅, 李瑜元, 聶玉強, 等. 內鏡下套扎與硬化治療食管靜脈曲張出血療效比較. 廣東醫學, 2002, 23(4): 370-372.
24.	楊玉龍, 王邦茂, 劉文天, 等. 急診內鏡治療肝硬化食管胃底靜脈曲張出血的療效觀察. 臨床薈萃, 2006, 21(12): 845-846.
25.	曾素琴, 呂仁發, 趙勇凱, 等. 食管靜脈曲張內鏡下套扎及硬化等聯合治療的比較觀察. 東南國防醫藥, 2006, 8(2): 99-101.
26.	張焰平, 李敏. 內鏡治療重度食管靜脈曲張破裂出血的臨床研究. 安徽衛生職業技術學院學報, 2004, 3(6): 35-36, 89.
27.	周平紅, 姚禮慶, 高衛東, 等. 內鏡治療食管靜脈曲張破裂出血(附385例報告). 中國內鏡雜志, 2001, 7(2): 14-17.
28.	Laine L, Cook D. Endoscopic ligation compared with schlerotherapy for treatment of esophageal variceal bleeding: a meta-analysis. Annals of Internal Medicine, 1995, 123(4): 280-287.
29.	Heresbach D,Jacquelinet C,Nouel O, et al. Sclerotherapy versus banding ligation for bleeding esophageal varices:meta analysis of randomized clinical trials. Gastroenterologie Cliniqueet Biologique, 1995, 19 (11): 914-920.
30.	Gross M, Schiemann U, Muhlhofer A, et al. Meta-analysis: efficacy of. therapeutic regimens in ongoing variceal bleeding. Endoscopy, 2001, 33(9): 737-746.
31.	范鐵艷, 程留芳. 結扎和硬化療法治療肝硬化食管靜脈曲張出血療效比較的薈粹分析. 世界華人消化雜志, 2006, 14(17): 1704-1709.

1. Liu HY. Internal medicine.6th ed. Beijing: The people health publishing house, 2004: 440.
2. Pan GZ, Cao SZ. Contemporary gastroenterology. Beijing: Science publishing house, 1994: 1515.
3. Liang XY, Zhou WH. Evidence based medicine and hepatopathy clinical practice. Modern Practical Medicine, 2005, 17(2): 119-121.
4. Li BQ, Zhang XJ, Ma LX, et al. A comparative study of esophageal varicosis treated by sclerotherapy or ligation and combination of ligation and sclerotherapy. Hebei Medical Journal, 2006, 28(10): 914-915.
5. Liu DL, Huo JR, Wu XP, et al. Comparative Clinical Study of Ligation Versus Sclerotherapy in the Treatment of Bleeding Esophageal Varices. HUNAN MEDICAL JOURNAL, 1999, 16(2): 90-92.
6. Liu YF, Sun YJ. A cinical study of endoscopic treatment methods in 99 cases of esophageal varices. Journal of Medical Science Yanbian University, 2003, 26(3): 193-196.
7. Qiu XD, Gu GM, Shi JP, et al. Comparative Study of Endoscopic Variceal Ligation and Endoscopic Sclerotherapy in Treat- ment of Variceal Hemorrhage. Chinese Journal of Gastroenterology, 2000, 5(4): 226-228.
8. Wang H, Li YY, Nie YQ, et al. Comparison of variceal band ligation with sclerotherapy for control of esophageal varices bleeding. Guangdong Medical Journal, 2002, 23(4): 370-372.
9. Yang YL, Wang BM, Liu WT, et al. Emergent endoscopic therapy for esophageal and gastric variceal bleeding of hepatic cirrhosis. Clinical Focus, 2006, 21(12): 845-846.
10. Zeng SQ, Lv RF, Zhao YK, et al. A comparative observation of esophageal varicosis treated by ligation, sclerotherapy or its combination. Journal of Southeast China Mational Defence Medical Science, 2006, 8(2): 99-101.
11. Zhang YP, Li M. To investigate the clinical result of sclerotherapy, banding ligationand sclerotherapy plus banding ligation sequential treatment in severe as ophagealvaricealbleeding. Journal of Anhui Health Vocational & Technical College, 2004, 3(6): 35-36, 89.
12. Zhou PH, Yao LQ, Gao WD, et al. Endoscopic therapy for the esophageal variceal bleeding. China Journal of Endoscopy, 2001,7(2): 14-17.
13. Fan TY, Liu FC. Comparison between effects of ligation and sclerotherapy in treatment of esophageal variceal bleeding after liver cirrhosis:a meta-analysis. World Chinese Journal of Digestology, 2006, 14(17): 1704-1709.
14. 劉厚鈺. 內科學. 第6版. 北京: 人民衛生出版社, 2004: 440.
15. 潘國宗, 曹世植. 現代胃腸病學. 北京: 科學出版社, 1994: 1515.
16. Schepis F, Camma C, Niceforo D, et al. Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection? Hepatology, 2001, 33(2):333-338.
17. Sarin SK, Lamba GS, Kumar M, et al. Comparison of endoscopic ligation and propranolol for the primary prevention of variceal bleeding. N Engl J Med, 1999, 340(13): 988-993.
18. 梁曉岳, 周文紅. 循證醫學與肝病臨床實踐. 現代實用醫學, 2005, 17(2): 119-121.
19. 李炳慶, 張學軍, 馬立新, 等. 內鏡下硬化治療、套扎及硬化治療加套扎治療食管靜脈曲張出血的對照研究. 河北醫藥, 2006, 28(10): 914-915.
20. 劉德良, 霍繼榮, 吳小平, 等. 套扎與硬化治療食管靜脈曲張出血的臨床對比研究. 湖南醫學, 1999, 16(2): 90-92.
21. 劉憶非, 孫遠杰. 內窺鏡直視下止血治療食道靜脈曲張出血——附99例報告. 延邊大學醫學學報, 2003, 26(3): 193-196.
22. 邱夏地, 顧國妹, 施建平, 等. 內鏡套扎術和硬化療法治療食管靜脈曲張破裂出血的比較研究. 胃腸病學, 2000, 5(4): 226-228.
23. 王紅, 李瑜元, 聶玉強, 等. 內鏡下套扎與硬化治療食管靜脈曲張出血療效比較. 廣東醫學, 2002, 23(4): 370-372.
24. 楊玉龍, 王邦茂, 劉文天, 等. 急診內鏡治療肝硬化食管胃底靜脈曲張出血的療效觀察. 臨床薈萃, 2006, 21(12): 845-846.
25. 曾素琴, 呂仁發, 趙勇凱, 等. 食管靜脈曲張內鏡下套扎及硬化等聯合治療的比較觀察. 東南國防醫藥, 2006, 8(2): 99-101.
26. 張焰平, 李敏. 內鏡治療重度食管靜脈曲張破裂出血的臨床研究. 安徽衛生職業技術學院學報, 2004, 3(6): 35-36, 89.
27. 周平紅, 姚禮慶, 高衛東, 等. 內鏡治療食管靜脈曲張破裂出血(附385例報告). 中國內鏡雜志, 2001, 7(2): 14-17.
28. Laine L, Cook D. Endoscopic ligation compared with schlerotherapy for treatment of esophageal variceal bleeding: a meta-analysis. Annals of Internal Medicine, 1995, 123(4): 280-287.
29. Heresbach D,Jacquelinet C,Nouel O, et al. Sclerotherapy versus banding ligation for bleeding esophageal varices:meta analysis of randomized clinical trials. Gastroenterologie Cliniqueet Biologique, 1995, 19 (11): 914-920.
30. Gross M, Schiemann U, Muhlhofer A, et al. Meta-analysis: efficacy of. therapeutic regimens in ongoing variceal bleeding. Endoscopy, 2001, 33(9): 737-746.
31. 范鐵艷, 程留芳. 結扎和硬化療法治療肝硬化食管靜脈曲張出血療效比較的薈粹分析. 世界華人消化雜志, 2006, 14(17): 1704-1709.

《中國循證醫學雜志》

套扎與硬化劑比較治療肝硬化食管靜脈曲張出血的中文隨機試驗的系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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《中國循證醫學雜志》

套扎與硬化劑比較治療肝硬化食管靜脈曲張出血的中文隨機試驗的系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料