Risk factors for glue extrusion bleeding after endoscopic therapy for esophagogastric variceal bleeding
-
摘要:
目的分析组织黏合剂注射治疗食管胃底静脉曲张后排胶出血的危险因素。方法收集2008年10月-2016年1月于首都医科大学附属北京地坛医院住院治疗的肝硬化食管胃底静脉曲张出血或曾经出血的416例患者的临床资料,包括性别、年龄、病因、血常规、肝肾功能、电解质、血脂、凝血、门静脉内径、脾前后径、Child-Pugh评分及组织黏合剂注射剂量等指标。计量资料组间比较采用t检验;多因素分析采用logistic回归分析。结果共59例患者出现排胶出血,发生率为14.18%。单因素分析显示,排胶出血患者和无排胶出血患者的TBil、DBil、总胆汁酸、Child-Pugh评分和组织黏合剂注射量比较差异均有统计学意义(t值分别为2.54、2.85、2.35、1.03、4.38,P值均<0.05)。多因素logistic回归分析显示,Child-Pugh评分(比值比=2.714,95%可信区间:1.6004.850,P=0.009)和组织黏合剂注射量(比值比=2.925,95%可信区间:1.7625.124,P=0.008)为排胶出血的独立危险因素。结论 Chi...
Abstract:Objective To investigate the risk factors for glue extrusion bleeding after endoscopic tissue adhesive injection for the treatment of esophagogastric variceal bleeding. Methods A total of 416 patients with liver cirrhosis complicated by esophagogastric variceal bleeding or a past history of bleeding who were admitted to Beijing Ditan Hospital, Capital Medical University, from October 2008 to January 2016 were enrolled. A retrospective analysis was performed for their clinical data, including sex, age, etiology, routine blood test results, hepatic and renal function, electrolytes, blood lipids, coagulation, diameter of the portal vein, anteroposterior diameter of the spleen, Child-Pugh score, and volume of tissue adhesive injection. The t-test was used for comparison of continuous data between groups, and a multivariate logistic regression analysis was also performed. Results Of all patients, 59 experienced glue extrusion bleeding, resulting in an incidence rate of 14. 18% . The univariate analysis showed that there were significant differences in total bilirubin, direct bilirubin, total bile acid, Child-Pugh score, and volume of tissue adhesive injection between the patients with glue extrusion bleeding and those without ( t = 2. 54, 2. 85, 2. 35, 1. 03, and 4. 38, all P < 0. 05) . The multivariate logistic regression analysis showed that Child-Pugh score ( odds ratio[OR]= 2. 714, 95% confidence interval[CI]1. 600-4. 850, P = 0. 009) and volume of tissue adhesive injection ( OR = 2. 925, 95% CI 1. 762-5. 124, P = 0. 008) were independent risk factors for glue extrusion bleeding. Conclusion Patients with higher Child-Pugh score and volume of tissue adhesive injection tend to have a higher risk of glue extrusion bleeding.
-
Key words:
- liver cirrhosis /
- esophageal and gastric varices /
- hemorrhage /
- risk factors
-
[1]FRANCO MC, GOMES GF, NAKAO FS, et al.Efficacy and safety of endoscopic prophylactic treatment with undiluted cyanoacrylate for gastric varices[J].World J Gastrointest Endosc, 2014, 6 (6) :254-259. [2]RENGSTORFF DS, BINMOELLER KF.A pilot study of 2-octyl cyanoacrylate injection for treatment of gastric fundal varices in humans[J].Gastrointest Endoc, 2004, 59 (4) :553-558. [3]SHARMA BC, VARAKANAHALLI S, SINGH JP, et al.Gastric varices in cirrhosis vs.extrahepatic portal venous obstruction and response to endoscopic N-butyl-2-cyanoacrylate injection[J].J Clin Exp Hepatol, 2017, 7 (2) :97-101. [4]KUMAR A, SINGH S, MADAN K, et al.Undiluted N-butyl cyanoacrylate is safe and effective for gastric variceal bleeding[J].Gastrointest Endosc, 2010, 72 (4) :721-727. [5]FUKUI H, SAITO H, UENO Y, et al.Evidence-based clinical practice guidelines for liver cirrhosis 2015[J].J Gastroenterol, 2016, 51 (7) :629-650. [6]WANG YM, CHENG LF, LI N, et al.Study of glue extrusion after endoscopic N-butyl-2-cyanoacrylate injection on gastric variceal bleeding[J].World J Gastroenterol, 2009, 15 (39) :4945-4951. [7] LINGHU EQ, FENG J.Endoscopic treatment of esophageal and gastric varices with TH glue[J].Chin J Dig Endosc, 2008, 25 (2) :59-60. (in Chinese) 令狐恩强, 冯佳.组织粘合剂在食管胃静脉曲张内镜治疗中的应用[J].中华消化内镜杂志, 2008, 25 (2) :59-60. [8]MA JL, LI P, ZHOU YL, et al.Clinical observation of adhesive discharge and bleeding after endoscopic tissue adhesive injection for gastric varices[J].Chin Hepatol, 2016, 21 (12) :1033-1034. (in Chinese) 马佳丽, 李坪, 周玉玲, 等.胃静脉曲张内镜下组织粘合剂注射治疗后排胶出血的临床观察[J].肝脏, 2016, 21 (12) :1033-1034. [9]GARCIA-PAGAN JC, BARRUFET M, CARDENAS A, et al.Management of gastric varices[J].Clin Gastroenterol Hepatol, 2014, 12 (6) :919-928. [10]AL-BAWARDY B, GOROSPE EC, SALEEM A, et al.Outcomes and predictors of rebleeding after 2-octyl cyanoacrylate injection in acute gastric variceal hemorrhage[J].J Clin Gastroenterol, 2016, 50 (6) :458-463. [11]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. [12]LI YJ.Effect of endoscopic ligation operation combined with tissue adhesive agent in the treatment of esophageal gastric varices and the influence factors of early rebleeding after treatment[J].China Med Herald, 2016, 13 (22) :65-68. (in Chinese) 李应杰.内镜下套扎术联合组织胶黏合剂治疗食管胃底静脉曲张的效果及治疗后早期再出血影响因素[J].中国医药导报, 2016, 13 (22) :65-68. [13]KUMAR AS, SIBIA RS.Predictors of in-hospital mortality among patients presenting with variceal gastrointestinal bleeding[J].Saudi J Gastroenterol, 2015, 21 (1) :43-46. [14]LEE CH, LEE JH, CHOI YS, et al.Natural history of gastric varices and risk factors for bleeding[J].Korean J Hepatol, 2008, 14 (3) :331-341. [15]ZANG LN, SUN ZQ, LI WB, et al.Meta-analysis of risk factors of gastroesophageal varices rebleeding after therapeutic endoscopy[J].Chin J Hepatol, 2015, 23 (4) :275-280. (in Chinese) 臧立娜, 孙自勤, 李文波, 等.食管胃静脉曲张经内镜治疗后再出血危险因素的Meta分析[J].中华肝脏病杂志, 2015, 23 (4) :275-280.
计量
- 文章访问数: 1882
- HTML全文浏览量: 55
- PDF下载量: 416
- 被引次数: 0