探讨不同套扎方式在急性食管静脉曲张破裂出血中的疗效差异。

回顾性分析2019年1月至2024年12月在天津医科大学第二医院消化内科行急诊内镜下食管静脉曲张套扎术(EVL)的168例患者的临床资料，按套扎方式分为破口套扎组(116例)和密集套扎组(52例)。比较两组患者套扎点数、术后24 h心率及收缩压、术后72 h及2周内再出血率、合并症发生情况等方面的差异。

破口套扎组的套扎点数显著低于密集套扎组(2.3 ± 1.3 vs. 10.3 ± 1.4，P<0.01)。术后24 h，两组患者在心率(68 ± 13次/分vs. 71 ± 11次/分)和收缩压(126±15 mmHg vs. 131 ± 12 mmHg)方面的差异均无统计学意义(均P> 0.05)。术后72 h内，破口套扎组的再出血率为0(0/116)，显著低于密集套扎组的5.8%(3/52，P<0.01)；而在术后72 h至2周内，两组再出血率差异无统计学意义(0 vs. 4.1%，P>0.05)。术后2周内，两组均未出现新发心脑血管疾病或急性肾损伤等合并症。

针对急性食管静脉曲张破裂出血，优先于出血点或血栓头处行破口套扎，可有效降低早期再出血风险，另外，套扎静脉球颜色变白可作为止血成功的标志。

To compare the efficacy of different ligation methods in the treatment of acute esophageal variceal bleeding.

A retrospective analysis was performed on the clinical data of 168 patients who underwent emergency endoscopic esophageal variceal ligation (EVL) in the Department of Gastroenterology, the Second Hospital of Tianjin Medical University, between January 2019 and December 2024.According to the ligation method, the patients were divided into targeted ligation group (n=116) and dense ligation group (n=52). The number of ligation points, heart rate and systolic blood pressure at 24 hours postoperatively, rebleeding rates within 72 hours and within 2 weeks, and the incidence of complications were compared between the two groups.

The number of ligation points in the targeted ligation group was significantly lower than that in the dense ligation group (2.3±1.3 vs.10.3±1.4, P<0.01). There were no significant differences in heart rate (68±13 vs. 71±11) or systolic blood pressure (126±15 mmHg vs. 131±12 mmHg) between the two groups at 24 hours after ligation (P>0.05). Within 72 hours after ligation, the rebleeding rate in the targeted ligation group was 0 (0/116), which was significantly lower than 5.8% (3/52) in the dense ligation group (P<0.01). There was no significant difference in the rebleeding rate between the two groups from 72 hours to 2 weeks after ligation (0 vs. 4.1%, P>0.05). No complications such as cardiovascular or cerebrovascular diseases or acute kidney injury occurred within 2 weeks postoperatively in both groups.

For acute esophageal variceal bleeding, targeted ligation has unique advantages for reducing the risk of early rebleeding. The whitening of the ligated variceal ball can be a sign of successful hemostasis.