食管静脉曲张套扎术治疗肝硬化食管静脉曲张破裂出血的效果观察

张东旭; 骆子义

doi:10.3969/j.issn.1001-5256.2017.01.016

食管静脉曲张套扎术治疗肝硬化食管静脉曲张破裂出血的效果观察

DOI: 10.3969/j.issn.1001-5256.2017.01.016

广东医科大学附属深圳市第三人民医院消化内科

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中图分类号: R575.2
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出版历程
- 收稿日期: 2016-09-09
- 出版日期: 2017-01-20

Clinical effect of esophageal variceal ligation in treatment of esophageal variceal bleeding in patients with liver cirrhosis

Department of Gastroenterology,The Third People's Hospital of Shenzhen,Guangdong Medical University

摘要

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
- 肝硬化 /
- 结扎术 /
- 食管和胃静脉曲张 /
- 治疗结果
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.
- liver cirrhosis /
- ligation /
- esophageal and gastric varices /
- treatment outcome

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参考文献(14)

[1]BOSCH J,ABRALDES JG,BERZIGOTTI A,et al.Portal hypertension and gastrointestinal bleeding[J].Semin Liver Dis,2008,28(1):3-25.

[2]MAO P,XIANG YL.Cause of early and late rebleeding after endoscopic variceal ligation and the nursing[J].China J Endosc,2013,19(7):732-735.(in Chinese)毛平,向亚利.内镜下套扎治疗食管静脉曲张术后早、晚期再出血的原因分析及处理[J].中国内镜杂志,2013,19(7):732-735.

[3] The esophageal and gastric varices group of the digestive endoscopy branch of the Chinese Medical Association.Specification for endoscopic diagnosis and treatment of gastrointestinal varices and bleeding(2009)[J].Chin J Dig Endosc,2010,27(1):1-4.(in Chinese)中华医学会消化内镜学分会食管胃静脉曲张学组.消化道静脉曲张及出血的内镜诊断和治疗规范试行方案(2009年)[J].中华消化内镜杂志,2010,27(1):1-4.

[4]Chinese Society of Hepatology,Chinese Medical Association;Chinese Society of Gastroenterology,Chinese Medical Association;Chinese Society of Endoscopy,Chinese Medical Association.Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J].J Clin Hepatol,2016,32(2):203-219.(in Chinese)中华医学会肝病学分会,中华医学会消化病学分会,中华医学会内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].临床肝胆病杂志,2016,32(2):203-219.

[5]WANG GL,WEN P,WEN JB,et al.Cost-effective analysis of pituitrin and somatostatin in treating esophageal and gastricvariceal bleeding[J].Mod J Integr Tradit Chin West Med,2010,19(18):2217-2218.(in Chinese)王桂良,文萍,文剑波,等.垂体后叶素与生长抑素治疗食管-胃底静脉曲张破裂出血成本-效果分析[J].现代中西医结合杂志,2010,19(18):2217-2218.

[6]HUANG GM,MA MY,ZHUANG ZH,et al.Effect of sengstaken-blakemore tube combined with suction catheter in esophageal varices bleeding patients[J].Chin Crit Care Med,2013,25(9):554-555.(in Chinese)黄国敏,马明远,庄志浩,等.三腔二囊管联合自制食道囊上注吸管在治疗食管胃底静脉曲张破裂出血中的应用[J].中华危重病急救医学,2013,25(9):554-555.

[7]YAO J,ZUO L,AN G,et al.Risk factors for hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with hepatocellular carcinoma and portal hypertension[J].J Gastrointestin Liver Dis,2015,24(3):301-307.

[8]ASCHA M,ABUQAYYAS S,HANOUNEH I,et al.Predictors of mortality after transjugular portosystemic shunt[J].World J Hepatol,2016,8(11):520-529.

[9]JU W,ZHANG BJ,HAN GH.Long-term therapeutic effect of transjugular intrahepatic portosystemic shunt in patierts with intractable cirrhotic ascites and prognostic factors[J].J Clin Hepatol,2016,32(8):1529-1533.(in Chinese)巨伟,张博静,韩国宏.经颈静脉肝内门体分流术治疗肝硬化顽固性腹水的长期效果及预后因素分析[J].临床肝胆病杂志,2016,32(8):1529-1533.

[10]DUAN XH,HAN XW,REN JZ,et al.Percutaneous transhepatic variceal embolization followed with partial splenic embolization for the acute variceal massive hemorrhage in cirrhosis[J].Chin J Hepatol,2015,23(5):372-375.(in Chinese)段旭华,韩新巍,任建庄,等.经皮胃冠状静脉栓塞术序贯脾栓塞治疗肝硬化消化道大出血的疗效观察[J].中华肝脏病杂志,2015,23(5):372-375.

[11]BARI K,GARCIA-TSAO G.Treatment of portal hypertension[J].World J Gastroenterol,2012,18(11):1166-1175.

[12]DAI C,LIU WX,JIANG M,et al.Endoscopic variceal ligation compared with endoscopic injection sclerotherapy for treatment of esophageal variceal hemorrhage:a meta-analysis[J].World J Gastroenterol,2015,21(8):2534-2541.

[13]FENG RB.Endoscopic variceal ligation withβ-blockers for prevention of secondary variceal bleeding in cirrhosis:a Meta-analysis[J].China Med Herald,2015,12(2):74-78.(in Chinese)冯瑞兵.内镜下套扎术联合β-受体阻滞剂预防肝硬化食管静脉曲张再出血的Meta分析[J].中国医药导报,2015,12(2):74-78.

[14]YU ZL.A re-evaluation of the efficacy of endoscopic ligation in the treatment of esophageal varices[J].Chin J Dig Endosc,2003,20(2):5-7.(in Chinese)于中麟.内镜下套扎治疗食管静脉曲张疗效的再评价[J].中华消化内镜杂志,2003,20(2):5-7.

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