中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2013年
9期
692-696
,共5页
食管和胃静脉曲张%结扎术%内窥镜检查,消化系统%手术后出血%复发
食管和胃靜脈麯張%結扎術%內窺鏡檢查,消化繫統%手術後齣血%複髮
식관화위정맥곡장%결찰술%내규경검사,소화계통%수술후출혈%복발
Esophageal and gastric varices%Ligation%Endoscopy,digestive system%Postoperative hemorrhage%Recurrence
目的 观察内镜下结扎术(EVL)对不同类型胃静脉曲张(GV)的治疗效果,分析术后复发及再出血的影响因素.方法 回顾性分析我院行EVL治疗的GV病例101例,随访1.5 ～ 48.0(14.90±9.08)个月,比较各型患者EVL术后止血成功率、早期再出血率、迟发性出血率、总体再出血率、GV消除率和复发率.32例完成腹部CT或CT血管造影术检查的患者,观察GV的供血血管、胃/脾-肾分流情况,测量门静脉、脾静脉直径,并分析其与GV复发之间的关系.计量资料比较用多样本均数方差分析,计数资料样本率比较用x2检验或Fisher确切概率法,等级资料比较用秩和检验；Kaplan-Meier检验比较各型GV再出血时间,log-rank检验比较再出血率差异.结果 1型食管胃静脉曲张(GOV1) 63例、2型食管胃静脉曲张(GOV2) 18例、GOV1+GOV211例、1型孤立性胃静脉曲张(IGV1)9例.GOV2、IGV1曲张程度较GOV1重(u值分别为-2.960和-2.871,P值均＜0.05).EVL治疗GV止血成功率为96.0％,再出血率为19.8％.GOV1的术后复发率20.6％,低于其他各型GV(x2=7.054,P＜0.05).CT或CT血管造影术显示GV患者均有胃左静脉供血,IGV1由胃左、胃短/后静脉共同参与供血者为83.3％,胃/脾-肾分流率为100.0％,均较其他各型患者高(Fisher确切概率法,P＜0.01或P＜ 0.05).56.3％ (18/32)的GV伴胃/脾-肾分流,有、无胃/脾-肾分流患者门静脉直径差异有统计学意义[(13.729±2.632) mm对比(17.164±4.229) mm,t=-2.766,P＜0.05],GV复发率和再出血率差异有统计学意义(复发率比较,61.1％对比28.6％,再出血率比较,33.3％对比7.1％,Fisher确切概率法,P均值＜ 0.05).结论 EVL可有效控制各型GV急性出血及防止再出血.各型GV中,EVL治疗GOV1的术后复发率低.GV合并胃/脾-肾分流者更易复发及再出血.
目的 觀察內鏡下結扎術(EVL)對不同類型胃靜脈麯張(GV)的治療效果,分析術後複髮及再齣血的影響因素.方法 迴顧性分析我院行EVL治療的GV病例101例,隨訪1.5 ～ 48.0(14.90±9.08)箇月,比較各型患者EVL術後止血成功率、早期再齣血率、遲髮性齣血率、總體再齣血率、GV消除率和複髮率.32例完成腹部CT或CT血管造影術檢查的患者,觀察GV的供血血管、胃/脾-腎分流情況,測量門靜脈、脾靜脈直徑,併分析其與GV複髮之間的關繫.計量資料比較用多樣本均數方差分析,計數資料樣本率比較用x2檢驗或Fisher確切概率法,等級資料比較用秩和檢驗；Kaplan-Meier檢驗比較各型GV再齣血時間,log-rank檢驗比較再齣血率差異.結果 1型食管胃靜脈麯張(GOV1) 63例、2型食管胃靜脈麯張(GOV2) 18例、GOV1+GOV211例、1型孤立性胃靜脈麯張(IGV1)9例.GOV2、IGV1麯張程度較GOV1重(u值分彆為-2.960和-2.871,P值均＜0.05).EVL治療GV止血成功率為96.0％,再齣血率為19.8％.GOV1的術後複髮率20.6％,低于其他各型GV(x2=7.054,P＜0.05).CT或CT血管造影術顯示GV患者均有胃左靜脈供血,IGV1由胃左、胃短/後靜脈共同參與供血者為83.3％,胃/脾-腎分流率為100.0％,均較其他各型患者高(Fisher確切概率法,P＜0.01或P＜ 0.05).56.3％ (18/32)的GV伴胃/脾-腎分流,有、無胃/脾-腎分流患者門靜脈直徑差異有統計學意義[(13.729±2.632) mm對比(17.164±4.229) mm,t=-2.766,P＜0.05],GV複髮率和再齣血率差異有統計學意義(複髮率比較,61.1％對比28.6％,再齣血率比較,33.3％對比7.1％,Fisher確切概率法,P均值＜ 0.05).結論 EVL可有效控製各型GV急性齣血及防止再齣血.各型GV中,EVL治療GOV1的術後複髮率低.GV閤併胃/脾-腎分流者更易複髮及再齣血.
목적 관찰내경하결찰술(EVL)대불동류형위정맥곡장(GV)적치료효과,분석술후복발급재출혈적영향인소.방법 회고성분석아원행EVL치료적GV병례101례,수방1.5 ～ 48.0(14.90±9.08)개월,비교각형환자EVL술후지혈성공솔、조기재출혈솔、지발성출혈솔、총체재출혈솔、GV소제솔화복발솔.32례완성복부CT혹CT혈관조영술검사적환자,관찰GV적공혈혈관、위/비-신분류정황,측량문정맥、비정맥직경,병분석기여GV복발지간적관계.계량자료비교용다양본균수방차분석,계수자료양본솔비교용x2검험혹Fisher학절개솔법,등급자료비교용질화검험；Kaplan-Meier검험비교각형GV재출혈시간,log-rank검험비교재출혈솔차이.결과 1형식관위정맥곡장(GOV1) 63례、2형식관위정맥곡장(GOV2) 18례、GOV1+GOV211례、1형고립성위정맥곡장(IGV1)9례.GOV2、IGV1곡장정도교GOV1중(u치분별위-2.960화-2.871,P치균＜0.05).EVL치료GV지혈성공솔위96.0％,재출혈솔위19.8％.GOV1적술후복발솔20.6％,저우기타각형GV(x2=7.054,P＜0.05).CT혹CT혈관조영술현시GV환자균유위좌정맥공혈,IGV1유위좌、위단/후정맥공동삼여공혈자위83.3％,위/비-신분류솔위100.0％,균교기타각형환자고(Fisher학절개솔법,P＜0.01혹P＜ 0.05).56.3％ (18/32)적GV반위/비-신분류,유、무위/비-신분류환자문정맥직경차이유통계학의의[(13.729±2.632) mm대비(17.164±4.229) mm,t=-2.766,P＜0.05],GV복발솔화재출혈솔차이유통계학의의(복발솔비교,61.1％대비28.6％,재출혈솔비교,33.3％대비7.1％,Fisher학절개솔법,P균치＜ 0.05).결론 EVL가유효공제각형GV급성출혈급방지재출혈.각형GV중,EVL치료GOV1적술후복발솔저.GV합병위/비-신분류자경역복발급재출혈.
Objective To investigate the therapeutic efficacy of endoscopic variceal ligation (EVL) for treating various types of gastric varices (GV) by reviewing patient cases in order to identify the influencing factors of EVL-related recurrence and rebleeding.Methods The medical records of 101 GV cases treated by EVL in our department between January 2008 and October 2012 were retrospectively reviewed.The cases were grouped according to GV type:type 1 (GOV1,n =63),type 2 (GOV2,n =18),GOV1 coexisting with GOV2 (n =11),isolated GOV1 (IGV1,n =9),and GOV2 (IGV2,n =0).Data from follow-up examinations (range:1.5 ～ 48.0 months,average:14.9 ± 9.1 months) were extracted for analysis and included early (＜ 72 h after EVL) and late (72 h to 6 weeks after EVL) rebleeding and recurrence.In addition,data from computed tomography (CT) or CT angiography (CTA),performed in 32 of the patients,were extracted to determine the influence of supplying veins,gastrorenal or splenorenal shunts,and portal vein and/or splenic vein diameters on GV recurrence.Data analysis was carried out by ANOVA,Chi-square,Fisher's exact or rank-sum tests,as appropriate.Kaplan-Meier analysis was used to evaluate the time of first recurrent bleeding,and the log-rank test was used to compare between-group differences.Results GOV2 and IGV1 varices were more severe than the varices of GOV1 (GOV2 and GOV1:u =-2.960; IGV1 and GOV1:u =-2.871; bothP ＜ 0.05).GOV1 had a significantly lower recurrence rate than all other GV types (x2 =7.054,P ＜ 0.05).The CT and CTA data indicated that all GV were supplied by left gastric veins,while 83.3％ of IGV1 had blood supplementation by left gastric veins and short gastric or posterior gastric veins,and 100％ of IGV1 had gastrorenal or splenorenal shunts.Approximately one-half of the total GV cases (56.3％,18/32) had gastrorenal or splenorenal shunts,and this parameter was correlated with portal vein diameter (t =-2.766,P ＜ 0.05).The presence of gastrorenal or splenorenal shunts was correlated with both recurrence and rebleeding (P ＜ 0.05).Conclusion EVL can effectively control bleeding and prevent rebleeding for GV; although,the best therapeutic efficacy and lowest rate of recurrence was achieved in GOV1 cases.The presence of gastrorenal or splenorenal shunts increases the risk of GV recurrence.
