肝硬化食管胃底静脉曲张合并脾大或脾亢的治疗方法研究
发布时间：2018-09-11 05:47
【摘要】：目的:探究内镜下治疗及内镜下治疗联合脾动脉部分栓塞两种治疗方法对肝硬化食管胃底静脉曲张破裂并发脾大或脾亢患者预后的影响。方法:本研究纳入肝硬化食管胃底静脉曲张破裂合并脾大或脾亢的患者29人,内镜治疗组(A组)患者14例,男性8例,女性6例,年龄31-75岁,平均年龄54.57±14.70岁。联合治疗组(B组)共15例患者,男性11例,女性4例,年龄40-71岁,平均年龄53.13±9.46岁。A组行内镜下食管曲张静脉套扎及胃底曲张静脉硬化治疗,初次内镜下治疗后2-4周行第2次治疗,直至曲张静脉消失或者患者不再进行治疗为止。B组患者行脾动脉部分栓塞治疗(与内镜下治疗间隔1-4周)及内镜下治疗(治疗方案同A组)。所有治疗结束后6个月或再次出血作为两组的观察终点。分别在术前、术后1及6个月检查患者的肝功、凝血系列、肾功、血常规、腹部B超或CT,评估Karnofsky行为状态(KPS)评分及肝脏Child-Pugh分级。比较两组术后1及6个月与术前的临床症状、体征、谷草转氨酶、谷丙转氨酶、总胆红素、白蛋白、凝血酶原时间、凝血酶原活动度、肌酐、白细胞、血小板、血红蛋白、KPS评分及肝脏Child-Pugh分级的变化,评估A、B两组的临床疗效,分析再出血的发生与可能危险因素的关系。结果:随访期间,A组1例酒精性肝硬化患者及1例病因不明肝硬化患者分别在术后第3和第6个月再次出血。B组1例乙型病毒性肝炎肝硬化患者及1例酒精性肝硬化患者分别在术后第2和第5个月再次呕血。A组套扎次数显著大于B组(P0.05)且两组患者再出血率无明显差异(两组中坚持治疗至曲张静脉消失者仅各有1例)。A组术后1月14例患者白蛋白改善显著(P0.05),谷草转氨酶、谷丙转氨酶、总胆红素、凝血酶原时间、凝血酶原活动度、肌酐、血红蛋白、血小板及白细胞水平与术前相比有所改善,但差异无显著性(P0.05)。13例患者术后6月的白蛋白及血红蛋白与术前相比有显著改善(P0.05),而其他以上提及的血液指标均无明显改善(P0.05)。术后1个月,14例患者中Child-Pugh A级百分比由71.43%增加到78.57%,Child-Pugh B级百分比维持于21.43%,1例Child-PughC级改善为B级。患者KPS改善不明显(P0.05)。术后6个月,Child-PughA级和Child-Pugh B级百分比分别为84.62%和15.38%。患者KPS改善显著(P0.05)。B组15例患者术后1个月的白蛋白、凝血酶原时间、血红蛋白、血小板及白细胞与术前相比明显改善(P0.05),谷草转氨酶、谷丙转氨酶、凝血酶原活动度、总胆红素和肌酐较术前并无显著差异(P0.05)。术后6个月13例患者的白蛋白、凝血酶原时间、凝血酶原活动度和血红蛋白、血小板及白细胞与术前相比改善明显(P0.05)。谷草转氨酶、谷丙转氨酶、总胆红素和肌酐与术前相比差异均不显著(P0.05)。术后1月15例患者中Child-Pugh A级百分比由60%增加到86.67%,Child-Pugh B级患者百分比由40%减少为13.33%。术后6个月13例患者的Child-Pugh分级均改善为A级。术后1月及6月时,患者KPS与治疗前相比均有显著改善(P0.05)。再出血的发生与术前食管静脉曲张的直径呈正相关关系。结论:脾动脉部分栓塞联合内镜下操作治疗肝硬化食管胃底静脉曲张破裂并发脾大或脾功能亢进安全、有效、可行,近期内可明显改善肝脏Child-Pugh分级和KPS评分。相比于内镜下治疗,联合治疗可明显改善患者的白细胞、血小板的水平及减少套扎次数。
[Abstract]:Objective: To investigate the effect of endoscopic treatment and endoscopic treatment combined with partial splenic artery embolization on the prognosis of patients with cirrhosis complicated by esophagogastric varices and splenomegaly or hypersplenism. There were 14 patients, 8 males and 6 females, aged 31-75 years, with an average age of 54.57 (+ 14.70). In the combined treatment group (group B), there were 15 patients, 11 males and 4 females, aged 40-71 years, with an average age of 53.13 (+ 9.46). In group A, the esophageal varices were ligated under endoscope and the gastric varices were sclerosed 2-4 weeks after the initial endoscopic treatment. Patients in group B received partial splenic artery embolization (1-4 weeks interval from endoscopic treatment) and endoscopic treatment (same treatment as group A). All patients were followed up for 6 months or bleeding again. Liver function and coagulation were examined before operation, 1 and 6 months after operation, respectively. Blood series, renal function, blood routine, abdominal ultrasonography or CT, Karnofsky behavior status (KPS) score and liver Child-Pugh grade were evaluated. The clinical symptoms, signs, glutamic oxaloacetic aminotransferase, alanine aminotransferase, total bilirubin, albumin, prothrombin time, prothrombin activity, creatinine, white blood cells, platelets, hemoglobin were compared between the two groups at 1 and 6 months after operation. Results: During the follow-up period, one alcoholic cirrhosis patient in group A and one unknown cirrhosis patient in group B had hemorrhage again at the 3rd and 6th month after operation. Patients with cirrhosis and 1 patient with alcoholic cirrhosis had hematemesis again at the 2nd and 5th month after operation. The number of ligations in group A was significantly higher than that in group B (P Enzyme, alanine aminotransferase, total bilirubin, prothrombin time, prothrombin activity, creatinine, hemoglobin, platelet and leukocyte levels were improved, but there was no significant difference (P 0.05). One month after operation, the percentage of Child-Pugh A increased from 71.43% to 78.57%, the percentage of Child-Pugh B remained at 21.43%, and that of Child-Pugh C was improved to B. The improvement of KPS was not significant in one patient (P 0.05). Six months after operation, the percentage of Child-Pugh A and Child-Pugh B were 84.62% and 15.38%, respectively. There was no significant difference in serum albumin, prothrombin time, hemoglobin, platelet and leukocyte (P 0.05), glutamic oxaloacetic aminotransferase, alanine aminotransferase, prothrombin activity, total bilirubin and creatinine (P 0.05) in group B at 1 month after operation. Prothrombin time, prothrombin activity and hemoglobin, platelets and white blood cells improved significantly (P 0.05). There were no significant differences in glutamic oxaloacetic aminotransferase, alanine aminotransferase, total bilirubin and creatinine between the two groups (P 0.05). The percentage of Child-Pugh A increased from 60% to 86.67% in 15 patients on January after surgery, and 100 in Child-Pugh B group. The Child-Pugh classification of 13 patients was improved to A grade at 6 months after operation. KPS was significantly improved at 1 month and 6 months after operation (P 0.05). There was a positive correlation between the occurrence of rebleeding and the diameter of esophageal varices before operation. Esophageal and gastric varices rupture with splenomegaly or hypersplenism is safe, effective and feasible, and can significantly improve the Child-Pugh classification and KPS score in the near future.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2
[Abstract]:Objective: To investigate the effect of endoscopic treatment and endoscopic treatment combined with partial splenic artery embolization on the prognosis of patients with cirrhosis complicated by esophagogastric varices and splenomegaly or hypersplenism. There were 14 patients, 8 males and 6 females, aged 31-75 years, with an average age of 54.57 (+ 14.70). In the combined treatment group (group B), there were 15 patients, 11 males and 4 females, aged 40-71 years, with an average age of 53.13 (+ 9.46). In group A, the esophageal varices were ligated under endoscope and the gastric varices were sclerosed 2-4 weeks after the initial endoscopic treatment. Patients in group B received partial splenic artery embolization (1-4 weeks interval from endoscopic treatment) and endoscopic treatment (same treatment as group A). All patients were followed up for 6 months or bleeding again. Liver function and coagulation were examined before operation, 1 and 6 months after operation, respectively. Blood series, renal function, blood routine, abdominal ultrasonography or CT, Karnofsky behavior status (KPS) score and liver Child-Pugh grade were evaluated. The clinical symptoms, signs, glutamic oxaloacetic aminotransferase, alanine aminotransferase, total bilirubin, albumin, prothrombin time, prothrombin activity, creatinine, white blood cells, platelets, hemoglobin were compared between the two groups at 1 and 6 months after operation. Results: During the follow-up period, one alcoholic cirrhosis patient in group A and one unknown cirrhosis patient in group B had hemorrhage again at the 3rd and 6th month after operation. Patients with cirrhosis and 1 patient with alcoholic cirrhosis had hematemesis again at the 2nd and 5th month after operation. The number of ligations in group A was significantly higher than that in group B (P Enzyme, alanine aminotransferase, total bilirubin, prothrombin time, prothrombin activity, creatinine, hemoglobin, platelet and leukocyte levels were improved, but there was no significant difference (P 0.05). One month after operation, the percentage of Child-Pugh A increased from 71.43% to 78.57%, the percentage of Child-Pugh B remained at 21.43%, and that of Child-Pugh C was improved to B. The improvement of KPS was not significant in one patient (P 0.05). Six months after operation, the percentage of Child-Pugh A and Child-Pugh B were 84.62% and 15.38%, respectively. There was no significant difference in serum albumin, prothrombin time, hemoglobin, platelet and leukocyte (P 0.05), glutamic oxaloacetic aminotransferase, alanine aminotransferase, prothrombin activity, total bilirubin and creatinine (P 0.05) in group B at 1 month after operation. Prothrombin time, prothrombin activity and hemoglobin, platelets and white blood cells improved significantly (P 0.05). There were no significant differences in glutamic oxaloacetic aminotransferase, alanine aminotransferase, total bilirubin and creatinine between the two groups (P 0.05). The percentage of Child-Pugh A increased from 60% to 86.67% in 15 patients on January after surgery, and 100 in Child-Pugh B group. The Child-Pugh classification of 13 patients was improved to A grade at 6 months after operation. KPS was significantly improved at 1 month and 6 months after operation (P 0.05). There was a positive correlation between the occurrence of rebleeding and the diameter of esophageal varices before operation. Esophageal and gastric varices rupture with splenomegaly or hypersplenism is safe, effective and feasible, and can significantly improve the Child-Pugh classification and KPS score in the near future.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2
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