内镜下套扎硬化序贯治疗食管曲张静脉疗效及预后影响因素的探讨

发布时间：2018-08-19 09:34

【摘要】：目的观察内镜下套扎(EVL)及硬化序贯治疗在肝硬化食管静脉曲张患者中应用的疗效,并研究预后的相关危险因素。方法收集未进行内镜下治疗的食管静脉曲张破裂出血患者设为对照组,仅进行药物治疗,共106例,研究组为内镜下治疗+药物治疗患者,入组共113例,研究组中又随机分为单纯套扎组(EVL组)和套扎硬化序贯组,观察治疗后曲张静脉消除率、再出血率、总治疗次数、死亡率和术中及术后并发症,进行比较。并比较对照组和研究组肝功能Child-Turcotte-Pugh(CTP)分级和终末期肝病模型(MELD)不同评分的再出血率和死亡率,分析预后影响因素,评价其对预后的诊断价值。结果对照组、EVL组和套扎硬化序贯组再出血率分别为41.51%、10.53%和10.64%,对照组与套扎硬化序贯组比较,差异有统计学意义(P=0.000);3组的死亡率分别为15.09%、5.26%和2.13%,对照组与EVL组、对照组与序贯组、EVL与序贯组比较,分别为P0.05、P=0.001和P0.05;套扎硬化序贯治疗的半年内复发率44.68%,EVL组复发率73.68%,两者比较差异有统计学意义(P=0.021);无论是对照组还是EVL组和序贯治疗组,肝功能CTP C级的再出血、死亡率明显高于A级;MELD模型中,受试者工作特征曲线(ROC)的曲线下面积(AUC)再出血率对照组、序贯组分别为0.944和0.851,死亡率两组分别为0.881和0.984,而复发率EVL组、序贯组分别为0.914和0.765,MELD评分对再出血和死亡的预测具有重要价值。结论套扎硬化序贯治疗能明显降低肝硬化食管曲张静脉患者的再出血率和死亡率,且套扎硬化序贯治疗的复发率要低于单纯套扎。肝功能CTP评分评级和MELD评分对再出血和死亡的预测均具有重要价值,套扎硬化序贯治疗能明显降低CTP为B级和C级静脉曲张的再出血和死亡率,并提高再出血和死亡的MELD阈值。
[Abstract]:Objective to observe the efficacy of endoscopic ligation of (EVL) and sclerosing in patients with esophageal varices and to study the prognostic risk factors. Methods 106 patients with esophageal variceal bleeding without endoscopic treatment were divided into control group (n = 106) and study group (n = 113). The study group was randomly divided into simple ligation group (EVL group) and ligation sclerosing sequential group. The rate of varicose vein elimination, rebleeding rate, total treatment times, mortality, intraoperative and postoperative complications were observed and compared. The rebleeding rate and mortality rate of Child-Turcotte-Pugh (CTP) grade of liver function and (MELD) score of end-stage liver disease model were compared between the control group and the study group. The prognostic factors were analyzed and the diagnostic value of the prognosis was evaluated. Results the rebleeding rates of EVL group and sclerosing group were 41 51% and 10 64% respectively. The mortality rates of control group and sclerosing group were 15. 09% and 2. 13%, respectively. The mortality rates of control group and sclerosing group were 2. 13% and 15. 09%, respectively. Compared with sequential group and sequential group, the recurrence rate of EVL was 44.68% in the control group and 73.68% in the sequential ligation group (P0. 021), both in the control group and in the EVL group and the sequential therapy group, and the recurrence rate was 44.68% in the sequentially ligated group (P0. 021), and there was a significant difference between the two groups (P0. 021), both in the control group, in the EVL group and in the sequential therapy group. The mortality rate of liver function CTP C grade rebleeding was significantly higher than that of A grade meld model. The area under the (ROC) curve of the subjects in the control group was 0.944 and 0.851respectively, and the mortality rate was 0.881 and 0.984 in the sequential group, while the recurrence rate was EVL group. Sequential meld scores of 0.914 and 0.765 were of great value in predicting rebleeding and death. Conclusion Sequential ligation sclerotherapy can significantly reduce the rate of recurrent bleeding and mortality in patients with cirrhosis and esophageal varices, and the recurrence rate of sequential ligation sclerotherapy is lower than that of simple ligation. Liver function CTP score and MELD score had important value in predicting rebleeding and death. Sequential ligation sclerotherapy could significantly reduce the rebleeding and mortality of CTP to grade B and C varices, and increase the MELD threshold of rebleeding and death.
【作者单位】：浙江省余姚市人民医院消化内科;
【基金】：浙江省医药卫生科技计划(No:2014ZHA008)
【分类号】：R575.2

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