食管胃静脉曲张出血内镜与手术治疗的疗效对比研究

发布时间：2018-06-10 13:43

本文选题：食管胃静脉曲张出血 + 内镜治疗　；参考：《福建医科大学》2015年硕士论文

【摘要】：目的:比较内镜下治疗与外科手术治疗肝硬化食管胃静脉曲张出血的疗效。材料与方法:回顾性分析160例食管胃静脉曲张出血的患者,根据治疗方式不同分为两组,其中行内镜下治疗72例(内镜治疗组),外科手术治疗88例(外科手术组),比较两组的急诊止血成功率、早期再出血率、迟发性出血率、静脉消失率、病死率及进行生存函数分析,并探讨内镜治疗后早期再出血的可能相关危险因素。结果:内镜治疗组早期再出血率明显高于外科手术组(37.5%vs7.95%,P=0.000),而其迟发性出血率远远低于外科手术组(5.88%vs 21.95%,P=0.000),静脉消失率亦显著高于外科手术组(70.83%vs 42.05%,p=0.001),差异均有统计学意义。Logistic回归分析提示既往行手术治疗史为内镜治疗后早期再出血的保护因素,而曲张静脉最大直径为内镜治疗后早期再出血的危险因素。内镜治疗组病死率较外科手术组高(16.66%vs 4.55%,P=0.028),而二者的远期生存率无明显差异。内镜治疗组与外科手术组在急诊止血成功率上亦无明显差异(98.61%vs 96.59%,p=0.628)。结论:对肝硬化食管胃静脉曲张出血,内镜治疗在近期疗效上较外科手术略差,但内镜治疗的静脉消失率及迟发性出血率均优于外科组,两种治疗方式在远期生存率上无差异。
[Abstract]:Objective: to compare the efficacy of endoscopic and surgical treatment for esophageal and gastric variceal hemorrhage due to cirrhosis. Materials and methods: 160 patients with esophageal and gastric variceal bleeding were retrospectively analyzed and divided into two groups according to different treatment methods. Among them, 72 cases were treated by endoscopy (endoscopic treatment group and 88 cases by surgical treatment). The success rate of emergency hemostasis, early rebleeding rate, delayed hemorrhage rate and venous disappearance rate were compared between the two groups. The mortality and survival function were analyzed and the risk factors of early rebleeding after endoscopic therapy were discussed. Results: the rate of early rebleeding in endoscopic group was significantly higher than that in surgical group (37.5vs 7.95), but the rate of delayed bleeding was much lower than that in surgical group (5.88 vs 21.95 P 0.000). The rate of venous disappearance was also significantly higher than that of surgical group (70.883 vs 42.05p0.001). Regression analysis showed that the history of previous surgical treatment was a protective factor for early rebleeding after endoscopic therapy. The maximum diameter of variceal vein was a risk factor for early rebleeding after endoscopic therapy. The mortality rate of endoscopic treatment group was higher than that of surgical operation group (16.66% vs 4.55%), but there was no significant difference in long-term survival rate between the two groups. There was no significant difference in the success rate of emergency hemostasis between the endoscopic treatment group and the surgical operation group (98.61 vs 96.59). Conclusion: in the treatment of esophageal and gastric variceal bleeding due to cirrhosis, the short-term curative effect of endoscopic treatment is slightly worse than that of surgical operation, but the rate of venous disappearance and delayed hemorrhage in endoscopic treatment is better than that in surgical group, and there is no difference in long-term survival rate between the two treatment methods.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.34

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