临床荟萃
臨床薈萃
림상회췌
CLINICAL FOCUS
2015年
3期
250-252,256
,共4页
葛秀珍%王玉明%郑忠青%王涛%王邦茂
葛秀珍%王玉明%鄭忠青%王濤%王邦茂
갈수진%왕옥명%정충청%왕도%왕방무
肝硬化%食管和胃静脉曲张%内窥镜检查%预后%危险因素
肝硬化%食管和胃靜脈麯張%內窺鏡檢查%預後%危險因素
간경화%식관화위정맥곡장%내규경검사%예후%위험인소
liver cirrhosis%esophageal and gastric varices%endoscopy%prognosis%risk factors
目的：探讨肝硬化静脉曲张套扎及硬化术后不良预后的危险因素。方法收集天津医科大学总医院内镜中心行内镜下食管胃底静脉曲张套扎术（endoscopic variceal ligation，EVL）和硬化术（endoscopic injection sclerotherapy，EIS）治疗患者142例，对其性别、年龄、肝硬化病因、是否合并糖尿病、动脉粥样硬化及脾切除术史以及术前实验室检查、影像学检查、内镜下治疗方式等因素进行统计分析。结果肝硬化食管胃底静脉曲张 EVL、EIS治疗不良预后的发生率为22．5％（32／142），病死率2．1％（3／142），存在不良预后因素者病死率高达9．4％（3／32）。其中术后早期出血率11．3％（16／142），术后感染率9．2％（13／142）。Child-Pugh分级、治疗方式、门静脉血栓、腹水程度、术前胆红素水平与治疗后预后不良相关（均P＜0．05），Child分级及门静脉血栓是内镜下治疗后预后不良的独立危险因素，OR值分别为4．006，14．06，95％CI 分别为1．742～9．215，3．527～56．113。结论 Child-Pugh分级、治疗方式、门静脉血栓、腹水程度、术前胆红素水平是食管胃底静脉曲张内镜下治疗预后的相关因素，门静脉血栓、Child-Pugh分级是食管胃底静脉曲张内镜下治疗预后不良的独立危险因素，行 EVL和 EIS治疗前应严格掌握适应证，术后密切监测并积极预防。
目的：探討肝硬化靜脈麯張套扎及硬化術後不良預後的危險因素。方法收集天津醫科大學總醫院內鏡中心行內鏡下食管胃底靜脈麯張套扎術（endoscopic variceal ligation，EVL）和硬化術（endoscopic injection sclerotherapy，EIS）治療患者142例，對其性彆、年齡、肝硬化病因、是否閤併糖尿病、動脈粥樣硬化及脾切除術史以及術前實驗室檢查、影像學檢查、內鏡下治療方式等因素進行統計分析。結果肝硬化食管胃底靜脈麯張 EVL、EIS治療不良預後的髮生率為22．5％（32／142），病死率2．1％（3／142），存在不良預後因素者病死率高達9．4％（3／32）。其中術後早期齣血率11．3％（16／142），術後感染率9．2％（13／142）。Child-Pugh分級、治療方式、門靜脈血栓、腹水程度、術前膽紅素水平與治療後預後不良相關（均P＜0．05），Child分級及門靜脈血栓是內鏡下治療後預後不良的獨立危險因素，OR值分彆為4．006，14．06，95％CI 分彆為1．742～9．215，3．527～56．113。結論 Child-Pugh分級、治療方式、門靜脈血栓、腹水程度、術前膽紅素水平是食管胃底靜脈麯張內鏡下治療預後的相關因素，門靜脈血栓、Child-Pugh分級是食管胃底靜脈麯張內鏡下治療預後不良的獨立危險因素，行 EVL和 EIS治療前應嚴格掌握適應證，術後密切鑑測併積極預防。
목적：탐토간경화정맥곡장투찰급경화술후불량예후적위험인소。방법수집천진의과대학총의원내경중심행내경하식관위저정맥곡장투찰술（endoscopic variceal ligation，EVL）화경화술（endoscopic injection sclerotherapy，EIS）치료환자142례，대기성별、년령、간경화병인、시부합병당뇨병、동맥죽양경화급비절제술사이급술전실험실검사、영상학검사、내경하치료방식등인소진행통계분석。결과간경화식관위저정맥곡장 EVL、EIS치료불량예후적발생솔위22．5％（32／142），병사솔2．1％（3／142），존재불량예후인소자병사솔고체9．4％（3／32）。기중술후조기출혈솔11．3％（16／142），술후감염솔9．2％（13／142）。Child-Pugh분급、치료방식、문정맥혈전、복수정도、술전담홍소수평여치료후예후불량상관（균P＜0．05），Child분급급문정맥혈전시내경하치료후예후불량적독립위험인소，OR치분별위4．006，14．06，95％CI 분별위1．742～9．215，3．527～56．113。결론 Child-Pugh분급、치료방식、문정맥혈전、복수정도、술전담홍소수평시식관위저정맥곡장내경하치료예후적상관인소，문정맥혈전、Child-Pugh분급시식관위저정맥곡장내경하치료예후불량적독립위험인소，행 EVL화 EIS치료전응엄격장악괄응증，술후밀절감측병적겁예방。
ABSTRACT:Objective To evaluate the risk factors in poor prognosis after endoscopic variceal ligation(EVL)and endoscopic injection sclerotherapy(EIS)of esophageal varices caused by liver cirrhosis.Methods A total of 142 cirrhotic patients with esophageal varices who received EVL or EIS at Endoscopy Center of Tianjin Medical University General Hospital were collected in this study.In order to discover risk factors,some items were analyzed,including gender,age, types of cirrhosis, existence of diabetes, atherosclerosis or splenectomy, serum examination and radiology examination and endoscopy treatment selection. Results The rate of poor prognosis after endoscopic treatment of esophageal varices was 22.5%(32/142),the mortality 2.1%(3/142),9.4%(3/32)in the patients with high risk factors,the rate of early rebleeding and infection after operation was 11.3%(16/142)and 9.2%(13/142), respectively.Single factor analysis showed significant differences in liver function Child-Pugh classification,treatment method,portal vein thrombosis(PVT),ascites degree and plasma bilirubin between good prognosis group and poor prognosis group(all P <0.05).Multi-factors logistic regression analysis showed that liver function Child-Pugh classification and PVT were the independent factors of poor prognosis after endoscopic treatment(both P<0.01),OR values were 4.006,14.06,95%CI 1.742-9.215,3.527-56.113.Conclusion Child-Pugh classification,treatment method,PVT,ascites degree and plasma bilirubin were associated with prognosis,PVT and Child-Pugh classification were independant risk factors of poor prognosis after endoscopic treatment.Good enrolling standard and close monitor after treatment were needed for preventing poor prognosis after EVL and EIS.
