• 1. 瀘州醫(yī)學(xué)院消化內(nèi)科（瀘州 646000）2. 瀘州醫(yī)學(xué)院公共衛(wèi)生學(xué)院3. 瀘州醫(yī)學(xué)院腎病內(nèi)科;

目的 　系統(tǒng)評(píng)價(jià)國(guó)內(nèi)有關(guān)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(jì)算機(jī)檢索CBMdisc（1979～2006）和CNKI（1994～2006），收集有關(guān)套扎與硬化劑比較治療肝硬化食管靜脈曲張出血的隨機(jī)對(duì)照試驗(yàn)（RCT）和半隨機(jī)對(duì)照試驗(yàn)（CCT），由兩名評(píng)價(jià)員獨(dú)立對(duì)納入文獻(xiàn)進(jìn)行質(zhì)量評(píng)價(jià)和數(shù)據(jù)提取，并使用RevMan4.2.7軟件進(jìn)行Meta分析。
結(jié)果 　共納入9個(gè)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(jié)果顯示：對(duì)于死亡率，兩組間差異有統(tǒng)計(jì)學(xué)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(duì)于急診止血率、出血復(fù)發(fā)率和并發(fā)癥發(fā)生率，套扎治療組也顯示出更好的療效趨勢(shì)；而對(duì)于曲張靜脈消失率和曲張靜脈復(fù)發(fā)率，硬化劑治療組則顯示出更好的療效趨勢(shì)。
結(jié)論 　在治療肝硬化食管靜脈曲張出血患者時(shí)，套扎較硬化劑治療顯示出更好的療效及更少的并發(fā)癥。但由于納入研究質(zhì)量不高，這一結(jié)論的強(qiáng)度受到一定的限制，尚需今后開(kāi)展高質(zhì)量隨機(jī)對(duì)照試驗(yàn)來(lái)進(jìn)一步驗(yàn)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(jī)試驗(yàn)的系統(tǒng)評(píng)價(jià). 中國(guó)循證醫(yī)學(xué)雜志, 2007, 07(2): 135-141. doi: 復(fù)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(nèi)科學(xué). 第6版. 北京: 人民衛(wèi)生出版社, 2004: 440.
15. 潘國(guó)宗, 曹世植. 現(xiàn)代胃腸病學(xué). 北京: 科學(xué)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(yī)學(xué)與肝病臨床實(shí)踐. 現(xiàn)代實(shí)用醫(yī)學(xué), 2005, 17(2): 119-121.
19. 李炳慶, 張學(xué)軍, 馬立新, 等. 內(nèi)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(duì)照研究. 河北醫(yī)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(duì)比研究. 湖南醫(yī)學(xué), 1999, 16(2): 90-92.
21. 劉憶非, 孫遠(yuǎn)杰. 內(nèi)窺鏡直視下止血治療食道靜脈曲張出血——附99例報(bào)告. 延邊大學(xué)醫(yī)學(xué)學(xué)報(bào), 2003, 26(3): 193-196.
22. 邱夏地, 顧國(guó)妹, 施建平, 等. 內(nèi)鏡套扎術(shù)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(xué), 2000, 5(4): 226-228.
23. 王紅, 李瑜元, 聶玉強(qiáng), 等. 內(nèi)鏡下套扎與硬化治療食管靜脈曲張出血療效比較. 廣東醫(yī)學(xué), 2002, 23(4): 370-372.
24. 楊玉龍, 王邦茂, 劉文天, 等. 急診內(nèi)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(fā), 趙勇凱, 等. 食管靜脈曲張內(nèi)鏡下套扎及硬化等聯(lián)合治療的比較觀察. 東南國(guó)防醫(yī)藥, 2006, 8(2): 99-101.
26. 張焰平, 李敏. 內(nèi)鏡治療重度食管靜脈曲張破裂出血的臨床研究. 安徽衛(wèi)生職業(yè)技術(shù)學(xué)院學(xué)報(bào), 2004, 3(6): 35-36, 89.
27. 周平紅, 姚禮慶, 高衛(wèi)東, 等. 內(nèi)鏡治療食管靜脈曲張破裂出血(附385例報(bào)告). 中國(guó)內(nèi)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(jié)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. 1. Liu HY. Internal medicine.6th ed. Beijing: The people health publishing house, 2004: 440.
  2. 2. Pan GZ, Cao SZ. Contemporary gastroenterology. Beijing: Science publishing house, 1994: 1515.
  3. 3. Liang XY, Zhou WH. Evidence based medicine and hepatopathy clinical practice. Modern Practical Medicine, 2005, 17(2): 119-121.
  4. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 14. 劉厚鈺. 內(nèi)科學(xué). 第6版. 北京: 人民衛(wèi)生出版社, 2004: 440.
  15. 15. 潘國(guó)宗, 曹世植. 現(xiàn)代胃腸病學(xué). 北京: 科學(xué)出版社, 1994: 1515.
  16. 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. 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. 18. 梁曉岳, 周文紅. 循證醫(yī)學(xué)與肝病臨床實(shí)踐. 現(xiàn)代實(shí)用醫(yī)學(xué), 2005, 17(2): 119-121.
  19. 19. 李炳慶, 張學(xué)軍, 馬立新, 等. 內(nèi)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(duì)照研究. 河北醫(yī)藥, 2006, 28(10): 914-915.
  20. 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(duì)比研究. 湖南醫(yī)學(xué), 1999, 16(2): 90-92.
  21. 21. 劉憶非, 孫遠(yuǎn)杰. 內(nèi)窺鏡直視下止血治療食道靜脈曲張出血——附99例報(bào)告. 延邊大學(xué)醫(yī)學(xué)學(xué)報(bào), 2003, 26(3): 193-196.
  22. 22. 邱夏地, 顧國(guó)妹, 施建平, 等. 內(nèi)鏡套扎術(shù)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(xué), 2000, 5(4): 226-228.
  23. 23. 王紅, 李瑜元, 聶玉強(qiáng), 等. 內(nèi)鏡下套扎與硬化治療食管靜脈曲張出血療效比較. 廣東醫(yī)學(xué), 2002, 23(4): 370-372.
  24. 24. 楊玉龍, 王邦茂, 劉文天, 等. 急診內(nèi)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. 25. 曾素琴, 呂仁發(fā), 趙勇凱, 等. 食管靜脈曲張內(nèi)鏡下套扎及硬化等聯(lián)合治療的比較觀察. 東南國(guó)防醫(yī)藥, 2006, 8(2): 99-101.
  26. 26. 張焰平, 李敏. 內(nèi)鏡治療重度食管靜脈曲張破裂出血的臨床研究. 安徽衛(wèi)生職業(yè)技術(shù)學(xué)院學(xué)報(bào), 2004, 3(6): 35-36, 89.
  27. 27. 周平紅, 姚禮慶, 高衛(wèi)東, 等. 內(nèi)鏡治療食管靜脈曲張破裂出血(附385例報(bào)告). 中國(guó)內(nèi)鏡雜志, 2001, 7(2): 14-17.
  28. 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. 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. 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. 31. 范鐵艷, 程留芳. 結(jié)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.