CAJ | 학술논문

目的探讨患者治疗顺应性对食管胃静脉曲张内镜治疗预后的影响.方法随访416例不同病因肝硬化食管胃静脉曲张内镜治疗后患者,按是否具备随访治疗顺应性条件分成顺应组及对照组,统计分析随访治疗顺应差异的原因构成,并比较两组之间再出血、死亡、再住院等随访指标的差异,以及根据肝功能Child-Pugh分级分层比较两组间的指标差异.两独立样本比较采用四格表资料的卡方检验.结果患者受教育程度、年收入状况及居住地医疗条件的差异决定随访顺应性的差异.食管胃静脉曲张患者内镜治疗术后总再出血率为35.1％(146/416),病死率为9.4％(39/416).顺应组的再出血率和病死率均显著低于对照组[26.1％(61/234)比46.7％(85/182),x2=19.137,P＜0.01;6.4％(15/234)比13.2％(24/182),x2=5.533,P=0.019].Child-Pugh A级273例患者中顺应组肝癌发现率(3.7％,10/273)、肝移植率(3.7％,10/273)、行脾脏切除十门奇静脉断流术手术率(6.6％,18/273)均高于对照组(x2=4.086,P=0.043；x2=4.086,p=0.043;x2=5.515,P=0.019).Child Pugh B级102例患者中顺应组和对照组的再出血(x2=21.297,P＜0.01)、死亡(x2=3.525,P=0.042)、腹水量(x2=4.451,P=0.035)、生活质量(x2=10.454,P=0.001)、肝功能情况(x2=8.197,P=0.004)差异均有统计学意义.Child-Pugh C级两组的各指标均差异无统计学意义(P均＞0.05).结论提高随访治疗顺应性能明显降低食管胃静脉曲张患者内镜治疗后再出血率和病死率,且能早期发现肝癌,早期肝移植干预,从而有效改善预后.
목적 탐토환자치료순응성대식관위정맥곡장내경치료예후적영향.방법 수방416례불동병인간경화식관위정맥곡장내경치료후환자,안시부구비수방치료순응성조건분성순응조급대조조,통계분석수방치료순응차이적원인구성,병비교량조지간재출혈、사망、재주원등수방지표적차이,이급근거간공능Child-Pugh분급분층비교량조간적지표차이.량독립양본비교채용사격표자료적잡방검험.결과 환자수교육정도、년수입상황급거주지의료조건적차이결정수방순응성적차이.식관위정맥곡장환자내경치료술후총재출혈솔위35.1％(146/416),병사솔위9.4％(39/416).순응조적재출혈솔화병사솔균현저저우대조조[26.1％(61/234)비46.7％(85/182),x2=19.137,P＜0.01;6.4％(15/234)비13.2％(24/182),x2=5.533,P=0.019].Child-Pugh A급273례환자중순응조간암발현솔(3.7％,10/273)、간이식솔(3.7％,10/273)、행비장절제십문기정맥단류술수술솔(6.6％,18/273)균고우대조조(x2=4.086,P=0.043；x2=4.086,p=0.043;x2=5.515,P=0.019).Child Pugh B급102례환자중순응조화대조조적재출혈(x2=21.297,P＜0.01)、사망(x2=3.525,P=0.042)、복수량(x2=4.451,P=0.035)、생활질량(x2=10.454,P=0.001)、간공능정황(x2=8.197,P=0.004)차이균유통계학의의.Child-Pugh C급량조적각지표균차이무통계학의의(P균＞0.05).결론 제고수방치료순응성능명현강저식관위정맥곡장환자내경치료후재출혈솔화병사솔,차능조기발현간암,조기간이식간예,종이유효개선예후.
Objective To investigate the influence of follow-up treatment compliance on prognosis after gastroesophageal varices treated under endoscopy.Methods Up to 416 liver cirrhosis patients after gastroesophageal varices treated under endoscopy were follow-up and divided into compliance group and control group according to whether the patients had follow-up treatment compliance condition.The factors caused the difference of follow-up treatment compliance were analyzed.The differences in the follow-up indexes such as rebleeding,mortality,rehospitalization were compared between the two groups.The differences in indexes between two groups were stratifiedly analyzed according to liver function Child-Pugh classification.Chi-square four data table test was for two independent samples comparison.Results The differences of education level,income and the medical condition of residential area determined the difference of follow-up compliance.After gastroesophageal varices patients treated under endoscopy,the total rebleeding rate was 35.1 ％ (146/416) and and the mortality rate was 9.4％ (39/416).The rebleeding rate and mortality rate of the compliance group were significantly lower than those of control group (26.1％ (61/234) vs 46.7％(85/182),x2=19.137,P＜0.01; 6.4％(15/234) vs 13.2％(24/182),x2=5.533,P=0.019).Among the 273 Child-Pugh A level patients,the detection rate of liver cancer (3.7％,10/273),liver transplantation rate (3.7％,10/273),splenectomy plus portal azygous disconnection rate (6.6％,18/ 273) of compliance group were higher than those of control group (x2 =4.086,P =0.043; x2 =4.086,P=0.043; x2 =5.515,P=0.019).Among the 102 Child-Pugh B level patients,there were statistical differences between compliance group and control group in rebleeding rate (x2 =21.297,P＜0.01),motality (x2=3.525,P=0.042),ascites (x2=4.451,P=0.035),life quality (x2 =10.454,P=0.001) and liver function (x2 =8.197,P=0.004).However,there were no statistical differences in all indexes between the two groups of Child-Pugh C level patients (all P＞0.05).Conclusion To improve the follow-up treatment compliance remarkably,decreased the rebleeding rate and mortality,contributed to early detection of liver cancer and early liver transplatation,thus the prognosis was improved consequently.