规范化内镜治疗肝硬化食管静脉曲张出血的预后分析

发布时间：2018-03-25 10:07

  本文选题：肝硬化　切入点：静脉曲张　出处：《重庆医科大学》2017年硕士论文

【摘要】：目的分析肝硬化食管静脉曲张(esophageal varices,EV)首次出血后,规范化行内镜下食管静脉曲张套扎(endoscopic variceal ligation,EVL)或联合胃静脉曲张组织胶注射术的临床效果。方法收集2012年2月至2014年6月期间,因肝硬化EV出血首次于重庆医科大学附属第一医院内镜室行内镜治疗成功的97例患者的临床资料,按后续是否规律内镜随访分为两组,对照组48例仅接受保守治疗,治疗组49例规律行内镜治疗,记录并分析两组治疗方案、曲张静脉变化及并发症、预后的差异。结果治疗组共49例患者,年龄位于25-72(50.31±9.97)岁;男30例,女19例,男女比例1.6:1。合并食管胃静脉曲张(Gastroesophageal varices,GOV)GOV1型22例,GOV2型12例,GOV3型4例。该组患者经过连续2-3次内镜治疗后EV缓解率100%,GV消除率93.75%。随访发现EV复发、再出血、死亡率1个月内分别为2.04%、0、0,12个月内分别为16.33%、4.08%、0,20个月内分别为20.40%、14.29%、4.08%,期间无胃静脉曲张出血(gastric varices bleeding,GVB)发生。对照组共48例患者,年龄位于26-74(51.56±10.32)岁。男31例,女17例,男女比例1.8:1。合并GOV1型21例,GOV2型10例,GOV3型7例。该组患者首次内镜治疗成功后未规律后续内镜随访,随访发现EV复发、再出血、死亡率1个月内分别为:4.17%、2.08%、2.08%,12个月内分别为41.67%、33.33%、8.33%,20个月内分别为72.92%、56.25%、20.83%,期间9例发生胃静脉曲张出血(18.75%)。结论肝硬化EV首次出血后再出血率高,规律胃镜随访、连续内镜下套扎2-3次,可明显缓解EV程度、预防再出血;对合并GV的患者及时行内镜下组织胶注射术,可有效消除GV、预防GVB。
[Abstract]:Objective to analyze the cirrhosis esophageal varices (esophageal varices, EV) after the first hemorrhage, standardized endoscopic esophageal variceal ligation (endoscopic variceal, ligation, EVL) clinical effect of gastric varices or combined with tissue glue injection operation. Methods from February 2012 to June 2014, the clinical data of 97 cases of hemorrhage of cirrhosis EV for the first time in First Affiliated Hospital of Chongqing Medical University Department of endoscopy endoscopic treatment were successful, according to the following rules if endoscopy were divided into two groups, 48 cases in the control group only received conservative treatment, 49 cases of endoscopic treatment group, treatment group two and record analysis, varicose vein changes and complications, prognosis is different. A total of 49 patients in the treatment group in 25-72, the age (50.31 + 9.97) years old; male 30 cases, female 19 cases, male to female ratio 1.6:1. of esophageal and gastric varices (Gastroesophageal, varices, GOV) GOV1 22 渚，

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