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Clinical effect of esophageal variceal ligation in treatment of esophageal variceal bleeding in patients with liver cirrhosis
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摘要:
目的观察内镜下食管静脉曲张套扎术（EVL）治疗肝硬化食管静脉曲张破裂出血（EVB）的临床疗效。方法收集2010年12月-2013年7月广东医科大学附属深圳市第三人民医院收治的肝硬化EVB患者84例,随机分为套扎组（A组,应用EVL联合生长抑素、埃索美拉唑治疗）、对照组（B组,应用生长抑素、埃索美拉唑治疗）,每组42例。观察2组止血率、再出血率、并发症发生率、病死率等,了解EVL后静脉曲张根除率、早期再出血相关危险因素。符合正态分布的计量资料2组间比较采用t检验,多组间比较采用方差分析;不符合正态分布的计量资料2组间比较采用Mann-Whitney U检验,组内两两比较采用Wilcoxn符号秩和检验,多组间比较采用Kruskal-Wallis H检验。计数资料组间比较采用χ2检验或Fisher确切概率法。生存率的计算采用KaplanMeier法,比较不同组别的生存情况采用log-rank检验。二分类资料的影响因素分析采用logistic回归方法。结果 A、B 2组止血率分别为97.62%、80.95%,差异有统计学意义（P=0.029）。A组1年2
Abstract:Objective To investigate the clinical effect of endoscopic esophageal variceal ligation( EVL) in the treatment of esophageal variceal bleeding( EVB) in patients with liver cirrhosis. Methods A total of 84 liver cirrhosis patients with EVB who were admitted to The Third People's Hospital of Shenzhen,Guangdong Medical University,from December 2010 to July 2013 were divided into ligation group( group A,treated with EVL combined with somatostatin and esomeprazole) and control group( group B,treated with somatostatin and esomeprazole),with 42 patients in each group. The hemostasis rate,rebleeding rate,incidence rate of complications,and mortality rate were observed in both groups,as well as the variceal eradication rate after EVL and risk factors for early rebleeding. The t- test was used for comparison of normally distributed continuous data between two groups,and an analysis of variance was used for comparison between multiple groups; the Mann- Whitney U test was used for comparison of non- normally distributed continuous data between two groups,the Wilcoxon signed- rank sum test was used for comparison within each group,and the Kruskal- Wallis H test was used for comparison between multiple groups. The chi- square test or Fisher's exact test was used for comparison of categorical data between groups. The Kaplan- Meier method was used to calculate survival rates,and the log- rank test was used to compare survival rates between groups. The logistic regression method was used to investigate the influencing factors for dichotomous data. Results There was a significant difference in the hemostasis rate between groups A and B( 97. 62% vs 80. 95%,P = 0. 029). Compared with group B,group A had significantly lower rebleeding rates in 1-2 years( 15. 38% vs 38. 89%,χ~2= 5. 323,P = 0. 021) and 2- 3 years( 15. 38% vs 48. 48%,χ~2= 10. 448,P = 0. 001). A total of 14patients( 33. 33%) in group A and 7 patients( 16. 67%) in group B experienced adverse events,and 4 patients in group A and 9 patients in group B died within 3 years. Group A had significant improvements in the levels of alanine aminotransferase( ALT) and aspartate aminotransferase at 1 week after treatment( Z =- 2. 177 and- 2. 044,P = 0. 029 and 0. 041). Both groups had significant improvements in prothrombin time activity( PTA),prothrombin time( PT),international normalized ratio( INR),and albumin at 1 week after treatment( group A: Z =- 4. 007,t = 3. 866,Z =- 4. 152,t =- 4. 623,all P < 0. 001; group B: t =- 5. 069,Z =- 3. 870,Z =- 3. 909,Z =-5. 245,all P < 0. 001). There was a significant difference in PTA at 1 week after treatment between the two groups( Z =- 3. 902,P <0. 001). In group A,the overall disappearance rate of varices was 85. 71% and the recurrence rate was 14. 29%,and there was a significant correlation between the Child- Pugh score and diameter of the portal vein( F = 3. 319,P = 0. 047). Symptoms on admission,length of hospital stay,Child- Pugh score,spontaneous bacterial peritonitis,diameter of the portal vein,PT,INR,and ALT were risk factors for early rebleeding after ligation( all P < 0. 05). Conclusion EVL is a safe and effective method for the treatment of EVB in patients with liver cirrhosis and causes few complications.
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Key words:
- liver cirrhosis /
- ligation /
- esophageal and gastric varices /
- treatment outcome
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