急诊脾切断流术与胃镜下硬化疗法治疗肝炎后肝硬化后门脉高压致上消化道出血患者预后及生活质量研究  

A retrospective study of disability index in emergency endoscopic sclerotherapy versus splenectomy-devascularization for bleeding varices in cirrhosis

作　　者：郭立民[1] 鲁岩[1] 李勤涛[1] 李宝亮[1] 张珂[1] 蒋力[1] 

机构地区：[1]首都医科大学附属北京地坛医院外科,北京100015

出　　处：《中华实验和临床感染病杂志（电子版）》2015年第2期42-45,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：北京市科委首都临床特色应用研究资助项目(No.Z121107001012169);首都医科大学附属北京地坛医院院内青年基金资助项目(No.QN2011-05)

摘　　要：目的本研究拟通过残疾指数(DI)指标比较急诊胃镜治疗与手术治疗对肝炎后肝硬化后门脉高压致上消化道出血(BEV)患者预后及生活质量的影响。方法选取2004年1月至2009年1月在首都医科大学附属北京地坛医院就诊的慢性肝硬化伴有急性上消化道出血患者共71例,其中33例行急诊脾切除+贲门周围血管离断手术,38例行急诊胃镜下注射硬化剂治疗,随访评估均超过5年。比较两组患者5年生存率及治疗后1、3和5年残疾指数。结果急诊手术组和胃镜组的5年存活率分别为84.85%(28/33)和76.32%(29/38),两组比较差异无统计学意义(x^2=0.797、P=0.350):手术组1年[251(7.61±3.65)vs 797(20.97±11.50)]、3年[558(16.91±6.77)vs 1 554(40.89±21.48)]及5年[967(29.30±11.81)vs 2 623(69.03±33.41)]的DI评分[总DI值(DI均数±标准差)]均显著低于胃镜组(P<0.001)。结论在治疗肝硬化后门脉高压致上消化道出血中,急诊手术治疗与胃镜治疗总5年存活率无显著性差异;但急诊手术患者治疗后具有更好的生活质量,有望成为门脉高压所致食管胃底静脉曲张破裂出血的一线治疗方法。Objective To compare the emergency endoscopic therapy（EST） versus splenectomydevascularization in the prognosis and the quality of life for cirrhosis patients with bleeding esophageal varices using disability index（DI）.Methods Total of 71 patients with cirrhosis who suffered from bleeding esophageal varices in Beijing Ditan Hospital,Capital Medical University from January 2004 to January 2009 were selected,among whom,there were 33 were treated with splenectomy-devascularization and 38 with emergency endoscopic therapy.All patients underwent more than 5 years follow-up evaluation.The DI was detected to describe the overall quality of life in patients.Results The 5-year survival rate was 84.85%（28/33） after splenectomy-devascularization and was 76.32%（29/38） after EST（x^2= 0.797,P = 0.350）.The splenectomy-devascularization had a significantly better DI than the EST in the first year[251（7.61 ± 3.65）vs 797（20.97 ± 11.50）],the third year[558（16.91 ± 6.77） vs 1 554（40.89 ± 21.48）]and the fifth year[967（29.30 ± 11.81） vs 2 623（69.03 ± 33.41）]（P 〈0.001）.Conclusions The 5-year survival rate showed no significant differences between the splenectomy-devascularization and the EST in the treatment for bleeding varices in cirrhosis.The splenectomy-devascularization results in a better quality of life and is expected to become the first-line therapy for bleeding varices in cirrhosis.

关 键 词：急诊脾切断流术 门静脉高压症 残疾指数 生活质量 食管静脉曲张出血 

分 类 号：R656[医药卫生—外科学]