食管静脉曲张结扎术的疗效及其与肝功能的关系  

Efficacy of endoscopic varieeal ligation and it＇s correlation with fiver function

作　　者：宋仁[1] 陈伟庆[1] 何璐[1] 梅浙川[1] 吴素华[1] 何松[1] 高健[1] 沈薇[1] 

机构地区：[1]重庆医科大学附属第二医院消化内科,400010

出　　处：《中华肝脏病杂志》2010年第12期886-889,共4页Chinese Journal of Hepatology

摘　　要：目的分析食管静脉曲张结扎术（EVL）的疗效及其与肝功能的关系。方法回顾性分析504例乙型肝炎后肝硬化患者的出血率与322例EVL和34例门奇静脉断流术后的出血率及病死率。对322例EVL患者据其术前Child—Pugh分级相应地分为A、B、C组{再按术前有无出血史分为两组。分析各组的结扎次数、术后出血与死亡情况；以及各组患者自身结扎前后肝功能、血常规、凝血功能及脾脏厚度等的变化。对数据采用x2检验、配对比较t检验、方差分析，以P〈0．05为差异有统计学意义。结果乙型肝炎肝硬化的年自然出血率为12．1％；门奇静脉断流术后Child—PughA、B、C级患者的总出血率为9．1％、14．3％、100．0%，病死率为0、9．5％、50．0％。Child-PughA、B、C组EVL根除结扎次数分别为（2．1±0．7）次、（3．1±0．8）次、（4．2±1．2）次，F=41．2，P〈0．01；有出血史各组结扎次数分别为（2．6±0．7）次、（3．2±0．9）次、（4．3±1．1）次，F=39．3，P〈0．01；无出血史各组结扎次数分别为（2．0±0．6）次、（2．7±0．6）次、（2．9±0．4）次，F=17．0，P〈0．01。Child Pugh A、B、C组EVL后总出血率分别为1．7％、3．4％、7．0％；病死率分别为0、5．1％、8．1％；有出血史患者结扎后ALT、AST、血小板、白细胞降低，脾脏厚度增加。结论EVL的疗效与肝功能Child—Pugh分级呈负相关，且优于门奇静脉断流止血术，EVL对肝功能无明显影响，但可使脾功能亢进加重。EVL尤其适用于肝硬化Child—Pugh B、C级的出血患者。Objective To analyze the efficacy of endoscopic variceal ligation and it＇s correlation with liver function. Methods 322 patiens received EVL（endoscopic variceal ligation） and 34 patients with PDP （pericardial devascularization procedure） were retrospectively analyzed and divided into groups A, B and C. These patients were then subdivided into bleeding and non-bleeding subgroups according to Child-Pugh scores of liver function and history of upper gastrointestinal bleeding. The bleeding rate and motality were contrasted between EVL and PDP. Liver function, Platelet count, leucocyte count and spleen thickness of before and after ligation were contrasted in EVL. Results The bleeding rate and mortality were 1.7%, 3.4%, 7.0%; 0%, 5.1%, 8.1% in EVL group and 9.1%, 14.3%, 100.0%; 0%, 9.5%, 50.0% in PDP group, respectively. Variceal obliteration needed means of 2.1± 0.7, 3.1 ± 0.8 and 4.2 ± 1.2 sessions in A, B and C ligation groups, respectively （F = 41.2, P 〈 0.01）. On subgroup analysis, the numbers of ligation session were 2.6 ± 0.7, 3.2 ± 0.9 and 4.3 ± 1.1 in A, B and C bleeding subgroup （F = 39.3, P 〈 0.01） and 2.0± 0.6, 2.7 ± 0.6, and 2.9 ± 0.4 in A, B and C non-bleeding subgroup, respectively （F = 17.0, P 〈 0.01）. ALT, AST, Platelet count and leucocyte count reduced significantly, spleen thickness increased remarkably in bleeding subgroup after ligation. Conclusion The efficacy of EVL was significantly negatively correlated with liver function and prior to pericardial devascularization procedure. EVL had no effect on liver function but might increase spleen thickness and aggravate hypersplenism. EVL was recommended especially for the bleeding liver cirrhosis patients with Child B and C scores.

关 键 词：肝硬化 静脉曲张 出血 结扎 

分 类 号：R686[医药卫生—骨科学]