食管静脉曲张择期内镜下套扎术后早期再出血及远期预后的回顾性分析  

Risk factors for early rebleeding after elective endoscopic variceal ligation（EVL） and long-term out- come： a retrospective analysis

作　　者：罗薛峰[2] 李肖[2] 王竹[1] 

机构地区：[1]四川大学华西医院消化内科,成都610041 [2]四川大学华西医院介入诊疗中心,成都610041

出　　处：《中华消化内镜杂志》2013年第12期668-670,共3页Chinese Journal of Digestive Endoscopy

基　　金：国家自然科学基金资助（81171444）

摘　　要：【摘要】目的探讨食管静脉曲张择期行内镜下静脉曲张套扎术（EVL）后早期再出血者的危险因素，并评估早期再出血者的远期预后。方法对198例肝硬化合并食管静脉曲张择期行EVL二级预防患者进行回顾性研究，26例EVL术后6周内发生再出血事件者纳人早期再出血组，其余172例纳入对照组，对比分析可能预测EVL术后发生早期再出血的危险因素，利用生存分析法比较两组患者远期预后，并进一步分析死亡原因。结果对比分析显示肝功能Child—Pugh分级（P=0．016）、肝功能Child—Pugh评分（P=0．012）、术前总胆红素水平（P=0．001）在早期再出血组和对照组间差异有统计学意义；进一步多因素分析发现术前总胆红素水平升高是EVL术后发生早期再出血的独立危险因素（OR=2．02，95％CI：1．04—4．14，P=0．008）。早期再出血组出血相关的死亡占66．7％（10／15），对照组仅占13．6％（6／44），差异有统计学意义（P〈0．01）；Kaplan—Miere生存分析显示，早期再出血组5年累积生存率为25．3％，对照组为67．8％，差异亦有统计学意义（P〈0．01）。结论食管静脉曲张择期EVL术后发生早期再出血患者的远期预后较差，而术前总胆红素水平较高可能提示术后发生早期再出血。Objective To evaluate the risk factors for early rebleeding （ERB） after elective endo- scopic variceal ligation （EVL） in cirrhotic patients and the influence of ERB on the long-term survival. Methods A total of 198 cirrhotic patients who received elective EVL were retrospectively evaluated. Twen- ty-six patients rebleeded within 6 weeks after initial EVL and were assigned to the ERB group. One hundred and seventy-two other cirrhotic patients were assigned to the control group. Multivariate analysis was used to define the high risk factors of ERB. A Kaplan-Meier analysis was performed to evaluate the cumulative sur- vival rates between two groups. Results The Child-Pugh classification （ P = 0. 016 ）, Child-Pugh scores （P =0. 012）, and the total bilirubin （P = 0. 001 ） were significantly different between ERB and control group. Multivariate analysis showed total bilirubin was the only independent risk factor of ERB （ OR = 2.02, 95%CI： 1.04-4.04, P = 0.008）. The proportional mortality indicator of bleeding-related deaths was 66. 7% （10/15） in ERB group and 13.6% （6/44） in control group （P 〈0. 01 ）. The five-year cumulative survival rate of the control-group was significantly higher than that of the rebleeding group （ 67. 8% vs. 25.3%, P 〈 0. Ol ）. Conclusion Cirrhotic patients with ERB after elective EVL have a poor prognosis. High level of total bilirubin may predict ERB.

关 键 词：【关键词】肝硬化 食管静脉曲张 再出血 内镜下静脉曲张套扎术 

分 类 号：R5[医药卫生—内科学]