门静脉血栓形成对内镜下食管静脉曲张套扎术临床疗效的影响  

Influence of portal vein thrombosis on clinical efficacy of endoscopic esophageal variceal ligation

作　　者：陈伶君 郭云蔚[1] 林颖[1] 郑丰平[1] 

机构地区：[1]中山大学附属第三医院消化内科,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2016年第3期153-157,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省科技计划项目(2008B030301038)

摘　　要：目的探讨门静脉血栓形成（PVT）对内镜下食管静脉曲张套扎术（EVL）治疗肝硬化食管静脉曲张破裂出血（EVH）疗效的影响。方法回顾性分析2005年1月至2014年12月在中山大学附属第三医院接受内镜下EVL治疗且随访超过6个月的314例肝硬化EVH患者临床资料。所有患者均签署知情同意书,符合医学伦理学规定。根据治疗时有否PVT将患者分为PVT组和对照组。其中PVT组72例,男61例,女11例;平均年龄（50±11）岁。对照组242例,男206例,女36例;年龄（47±11）岁。比较两组患者的临床疗效,分析PVT与食管静脉曲张（EV）消除率、EV再出血率的关系。两组EVL疗程数比较采用t检验,率的比较采用χ~2检验。PVT与EV消除率、EV再出血率的关系采用单因素logistic回归分析。结果 PVT组发生急性EVH 36例,对照组115例,经EVL治疗后两组急诊止血率均为100%。PVT组EV消除率为76%（55/72）,明显低于对照组的90%（218/242）（χ~2=9.166,P〈0.05）。PVT组EVL疗程数为（3.4±1.6）个,明显多于对照组的（2.8±1.1）个（t=3.065,P〈0.05）。PVT组EV再出血率为36%（26/72）,明显高于对照组的21%（51/242）（χ~2=6.779,P〈0.05）。PVT是影响患者EV消除率的危险因素（OR=0.356,95%CI：0.179~0.709,P〈0.05）,亦是影响患者EV再出血的危险因素（OR=2.383,95%CI：1.354~4.196,P〈0.05）。结论 PVT是影响内镜下EVL治疗肝硬化EVH患者EV消除率及再出血率的危险因素。Objective To explore the influence of portal vein thrombosis（PVT） on the clinical efficacy of endoscopic esophageal variceal ligation（EVL） in cirrhotic patients with esophagogastric variceal hemorrhage（EVH）.Methods Clinical data of 314 cirrhotic patients with EVH who underwent endoscopic EVL and were followed up for more than 6 months in the Third Affiliated Hospital of Sun Yat-sen University between January 2005 and December 2014 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.The patients were divided into the PVT group and the control group according to whether they had PVT during treatment.Among the 72 patients in the PVT group,61 were males and 11 were females with the mean age of（50±11） years old.Among the 242 patients in the control group,206 were males and 36 were females with the mean age of（47±11） years old.The clinical efficacy of two groups was compared,and the correlation between PVT and the elimination rate of esophageal varices（EV） as well as the recurrent bleeding rate of EV was analyzed.The number of EVL treatment period in two groups was compared using t test and the rate was compared using Chi-square test.Univariate logistic regression analysis was conducted for the correlation between PVT and the elimination rate,recurrent bleeding rate of EV.Results Thirty-six patients in the PVT group and 115 patients in the control group developed acute EVH.After EVL,the emergency hemostatic rate of both groups was 100%.The elimination rate of EV in the PVT group was 76%（55/72）,significantly lower than 90%（218/242） in the control group（χ~2=9.166,P〈0.05）.The number of EVL treatment period in the PVT group was 3.4±1.6,significantly more than 2.8±1.1 in the control group（t=3.065,P〈0.05）.The recurrent bleeding rate of EV in the PVT group was 36%（26/72）,significantly higher than 21%（51/242） in the control group（χ~2=6.779,P〈0.05）.PVT was a risk factor for both the

关 键 词：门静脉 肿瘤细胞 循环 肝硬化 食管和胃静脉曲张 胃镜 治疗应用 

分 类 号：R575.2[医药卫生—消化系统]