超声内镜对食管静脉曲张套扎术后复发的预测作用  

The predictive value of endoscopic ultrasound for the recurrence of esophageal varices after endo- scopic esophageal varix ligation

作　　者：李爽[1] 张德发[1] 陆伟[1] 胡东胜[1] 王春妍[1] 郭小苓[1] 文君[1] 姬向军 周晓东[1] 

机构地区：[1]天津市第二人民医院内镜诊疗科,300192

出　　处：《中华消化内镜杂志》2016年第4期223-228,共6页Chinese Journal of Digestive Endoscopy

基　　金：天津市卫计委科技基金（2015KR18）

摘　　要：目的通过探讨食管静脉曲张患者超声内镜下食管侧枝静脉（ECV）表现与套扎术后食管静脉曲张复发的关系，评估超声内镜对食管静脉曲张套扎术（EVL）术后复发的预测价值。方法60例肝硬化门脉高压合并食管静脉曲张患者接受EVL治疗直至曲张静脉完全消失，治疗前行普通内镜和超声内镜检查并描述食管静脉曲张情况及ECV等级、位置、数量，在治疗结束后的12个月内动态监测食管静脉曲张复发情况，并应用统计学方法明确EVL术后食管静脉曲张复发与ECV的相关性。结果60例患者中，有29例（48．3％）在EVL术后12个月内复发食管静脉曲张。单变量逻辑回归分析显示，重度食管周围侧枝静脉（OR=22．67，95％CI：4．37—117．47，P〈0．001）、重度食管旁侧枝静脉（OR=16．31，95％CI：0．84～108．14，P=0．018）、多发（≥5条）食管周围侧枝静脉（OR=22．67，95％CI：4．37～117．47，P〈O．001）及存在穿支静脉（OR=6．67，95％CI：1．46～30．43，P=0．014）与EVL术后食管静脉曲张复发存在相关性。多元逻辑回归模型分析发现重度食管周围侧枝静脉（OR：24．39，95％CI：2．34～253．78，P：0．008）、多发食管周围侧枝静脉（OR=24．39，95％CI：2．34—253．78，P=0．008）、重度食管旁侧枝静脉（OR=19．42，95％CI：4．84—148．54，P=0．012）为静脉曲张复发的独立危险因子。重度食管周围侧枝静脉和多发食管周围侧枝静脉预测EVL术后12个月内出现静脉曲张复发的敏感度和特异度分别为89．2％和90．5％，总预测价值较高（ROC曲线下面积=0．946）；重度食管旁侧枝静脉在此方面的敏感度和特异度分别为86．4％和87．7％，亦具有较高的预测价值（ROC曲线下面积=0．871）。结论EVL术后食管静脉曲张复发率较高，超声内镜可清晰描述食管侧枝静脉，重度食管周围侧枝静脉和多发食管周围�Objective To assess the relationship between the recurrence of esophageal varices fol- lowing endoscopic esophageal varix ligation （EVL） and esophageal collateral veins（ECV） under endoscopic ultrasound （EUS）, and analyze the predictive value of EUS for recurrence of esophageal varices. Methods Sixty patients with cirrhotic portal hypertension combined with esophageal variees underwent EVL for eradica- tion of varices. Endoscopy and EUS were performed before ligation to detect and describe the type of esopha- geal varices, and grade, location, and the number of ECV. Over a 12-month period, variceal recurrence was examined. The statistical analyses were performed to assess the relationship between esophageal varices fol- lowing EVL and ECV. Results Of the 60 patients, 29 （48.3%） had variceal recurrence within 12 months after EVL. Univariate logistic regression analysis showed that severe peri-ECV （OR = 22. 67; 95%CI： 4. 37-117.47, P〈0. 001 ） ,severe para-ECV（ OR= 16. 31 ; 95%CI： 0. 84-108.14, P=0. 018） , multiple peri-ECV （ OR = 22. 67; 95%CI： 4. 37-117.47, P〈0. 001 ）, and the presence of perforating veins （ OR = 6. 67,95% CI： 1.46-30.43, P= 0. 014） were significantly related to the variceal recurrence after EVL. Multivariate logis- tic regression model showed that severe peri-ECV （ OR= 24. 39; 95%CI： 2. 34-253.78,P=0. 008） and mul- tiple peri-ECV （ OR=24. 39; 95%CI： 2. 34-253.78,P= 0. 008） severe para-ECV （ OR = 19.42; 95%CI： 4. 84-148.54,P = 0. 012）remained independent prognostic factors for varieeal recurrence. The sensitivity and specificity of multivariate logistic regression model in predicting variceal recurrence were 89. 2% and 90. 5%, respectively （prognostic value AUC = 0. 946）.The sensitivity and specificity were 86.4% and 87.7% in pre- dicting variceal recurrence（ prognostic value AUC = 0. 871 ）. Conclusion Recurrence rate of esophageal var- ices after EVL is high. EUS can clearly depict ECV. Severe peri-ECV and multiple peri-ECV are

关 键 词：食管和胃静脉曲张 内镜治疗 预测 超声内镜 

分 类 号：R655.4[医药卫生—外科学]