食管胃底静脉曲张内镜下套扎及组织胶注射术后早期再出血的危险因素分析  

Risk factors of early rebleeding after endoscopic variceal ligation and/or endoscopic injection of flbrin tissue adhesive

作　　者：梁文燕[1] 李鹏[2] 冀明[2] 张澍田[2] 

机构地区：[1]首都医科大学附属怀柔区第一医院消化科,北京101400 [2]首都医科大学附属北京友谊医院消化内科

出　　处：《中华消化内镜杂志》2012年第10期541-544,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的初步探讨食管胃底静脉曲张患者行内镜下静脉曲张套扎术（EVL）及内镜下组织胶注射术后早期再出血的独立危险因素。方法回顾性总结370例396例次肝硬化食管胃底静脉曲张出血或曾经出血为预防再出血而行EVL和（或）内镜下组织胶注射术治疗患者的临床资料，分析术后早期再出血患者群与未出血患者群间的差异性因素，并引入Logistic回归分析以寻找独立危险因素。结果是否有合并症、腹水、门静脉宽度、Child—Pugh分值、蓝色曲张静脉、胆碱酯酶、白蛋白水平在术后早期再出血患者和未出血患者群中分布差异明显（P均〈0．05）；Logistic回归分析发现腹水、门静脉宽度、Child—Pugh分值、白蛋白水平为EVL及内镜下组织胶注射术后早期再出血的独立危险因素（P值分别为0．011、0．008、0．009和0．005），进一步进行分层分析得出随着腹水量增多、门静脉宽度增加、白蛋白减少、Child—Pugh分值大于10分后，EVL及内镜下组织胶注射术后发生早期再出血的危险陛明显增加。结论腹水量、门静脉宽度、Child—Pugh分值及白蛋白水平可明显影响食管胃底静脉曲张患者行EVL及组织胶注射术后早期再出血的发生。Objective To study the independent risk factors of early rebleeding after endoscopic variceal ligation （EVL） and/or endoscopic injection of fibrin tissue adhesive. Methods Data of 370 patients Who had cirrhosis and accepted 396 procedures of EVL and/or endoscopic injection of fibrin tissue ad hesive were retrospectively studied. Independent risk factors for early rebleeding were determined by Logistic regression analysis. Results Results of all the factors that were significantly different between the rebleed ing and nonrebleeding patients, the portal vein diameter, ascites volume, ChildPugh score and serum albu min were independent ones of early rebleeding after EVL and/or endoscopic injection of fibrin tissue adhesive （P 〈 0. 05）. Larger volume of ascites, wider portal vein diameter, reduced albumin, ChildPugh score grea ter than 10 were indicative factors of rebleeding. Conclusion The early rebleeding rate after EVL and/or endoscopic injection of fibrin tissue adhesive is determined by portal vein diameter, ascites volume, Child Push score, and serum albumin.

关 键 词：食管和胃静脉曲张 内镜下食管曲张静脉结扎 内镜下组织胶注射 术后早期 再出血 

分 类 号：R575.2[医药卫生—消化系统]