老年肝硬化患者内镜下食管静脉曲张套扎术的效果及安全性  

Efficacy and safety of endoscopic esophageal variceal ligation in esophageal variceal bleeding in elderly patients with hepatic cirrhosis

作　　者：赵莉[1] 许乐[1] 

机构地区：[1]北京医院消化科,100730

出　　处：《中华消化杂志》2015年第6期361-366,共6页Chinese Journal of Digestion

摘　　要：目的评价老年肝硬化合并食管静脉曲张出血（EVB）患者采用内镜下静脉曲张套扎术（EVL）的治疗效果，以及在无痛胃镜下操作的安全性。方法回顾性分析2007年7月至2013年7月确诊为肝硬化合并EVB的170例患者的病历资料，其中139例行EVL，分成老年麻醉组（年龄≥60岁）52例，老年非麻醉组（年龄≥60岁）45例，非老年麻醉组（年龄〈60岁）42例；另31例（年龄≥60岁）使用普奈洛尔进行药物治疗。分析各组在胃镜下操作的视野满意度和食管蠕动情况满意度，食管静脉曲张的治疗效果及复发情况，不良反应、并发症和死亡情况。统计学方法采用双因素方差分析或行×列表卡方检验。结果老年麻醉组在胃镜下操作的视野满意度和食管蠕动情况满意度分别为82．5％（104／126）和89．7％（113／126），非老年麻醉组分别为82．6％（71／86）和89．5％（77／86），老年非麻醉组分别为40．3％（29／72）和44．4％（32／72），麻醉组均好于非麻醉组（χ^2=47．46，64．28；P均〈0．01）。老年麻醉组、老年非麻醉组、非老年麻醉组的食管曲张静脉治疗有效率分别为84．6％（44／52）、68．9％（31／45）、81．0％（34／42），复发率分别为19．2％（10／52）、20．0％（9／45）、19．0％（8／42），差异均无统计学意义（P均〉0．05）；药物治疗组的再出血率为58．1％（18／31），明显高于老年麻醉组[19．2％（10／52）]、老年非麻醉组[31．1％（14／45）]和非老年麻醉组[23．8％（10／42）]，差异有统计学意义（χ^2=15．10，P〈0．01）。老年麻醉组和非老年麻醉组患者术后无肝性脑病发生；老年非麻醉组的吸入性肺炎发生率为4．2％（3／72），高于老年麻醉组和非老年麻醉组的0，差异有统计学意义（χ^2=8．93，P=0．01）；老年麻醉组、老年非麻醉组、非老年麻醉组行EVL后1个月内病死�Objective To evaluate the efficacy of endoscopic variceal ligation（EVL） in esophageal variceal bleeding （EVB） in elderly patients with hepatic cirrhosis, and the safety of endoscopic operation under anesthesia. Methods From July 2007 to July 2013, 170 patients diagnosed as liver cirrhosis complicated with EVB were retrospectively analyzed. Among them, 139 patients who received EVL were divided into elderly anesthesia group （n=52, age≥60 years）, elderly non-anesthesia group （n=45, age≥ 60 years） and non-elderly anesthesia group （n=42, age≥60 years）; the other 31 cases （age≥60 years） received propranolol therapy. The degree of satisfaction of visual fields and esophageal peristalsis under the gastroscope, the effect, adverse effects and complications of EVL, the recurrence of EVB and mortality of each group were analyzed. Two-way analysis of variance and crosstabs chi square test were performed for statistical analysis. Results The satisfaction rate of visual fields and esophageal peristalsis under the gastroscope were 82.5% （104/126） and 89.7%（113/126） in elderly anesthesia group; 82.6% （71/86） and 89.5% （77/86） in non-elderly anesthesia group; 40.3%（29/72） and 44.4% （32/72） in elderly non-anesthesia group. The satisfaction rate of visual fields and esophageal peristalsis under the gastroscope in anesthesia group were better than those in non-anesthesia group （χ^2 =47.46, 64.28; both P%0.01）. The efficacy rates of EVL in elderly anesthesia group, elderly non-anesthesia group and non-elderly anesthesia group were 84.6%（44/52）, 68.9% （31/45） and 81.0% （34/42）, respectively. The variceal recurrence rates were 19. 2% （10/52） , 20. 0% （9/45） and 19. 0% （8/42）, respectively. There was no significant difference among them （all P 〉 0.05）. Rebleeding rate of medication treatment group was 58.1%（18/31）, which was obviously higher than that of elderly anesthesia group （19. 2%, 10/52）, elderly non-anesthesia group （31.1%, 14/4

关 键 词：老年人 食管静脉曲张套扎术 二异酚 

分 类 号：R575.2[医药卫生—消化系统]