内镜下套扎硬化序贯治疗食管曲张静脉疗效及预后影响因素的探讨  

Efficacy of sequential endoscopic variceal ligation plus endoscopic variceal sclerotheropy and the factors associated with the prognosis

作　　者：桑建忠[1] 张红[1] 周建波[1] 宋奇峰[1] 孙晓辉[1] 黄戬[1] 施煜燕[1] 杨倩倩[1] 蔡升[1] Jian-zhong Sang;Hong Zhang;Jian-bo Zhou;Qi-feng Song;Xiao-hui Sun;Jian Huang;Yu-yan Shi;Qian-qian Yang;Sheng Cai(Department of Gastroenterology, Yuyao People’s Hospital, Yuyao, Zhejiang 315400, China)

机构地区：[1]浙江省余姚市人民医院消化内科,浙江余姚315400

出　　处：《中国内镜杂志》2017年第3期56-63,共8页China Journal of Endoscopy

基　　金：浙江省医药卫生科技计划(No:2014ZHA008)

摘　　要：目的观察内镜下套扎(EVL)及硬化序贯治疗在肝硬化食管静脉曲张患者中应用的疗效,并研究预后的相关危险因素。方法收集未进行内镜下治疗的食管静脉曲张破裂出血患者设为对照组,仅进行药物治疗,共106例,研究组为内镜下治疗+药物治疗患者,入组共113例,研究组中又随机分为单纯套扎组(EVL组)和套扎硬化序贯组,观察治疗后曲张静脉消除率、再出血率、总治疗次数、死亡率和术中及术后并发症,进行比较。并比较对照组和研究组肝功能Child-Turcotte-Pugh(CTP)分级和终末期肝病模型(MELD)不同评分的再出血率和死亡率,分析预后影响因素,评价其对预后的诊断价值。结果对照组、EVL组和套扎硬化序贯组再出血率分别为41.51%、10.53%和10.64%,对照组与套扎硬化序贯组比较,差异有统计学意义(P=0.000);3组的死亡率分别为15.09%、5.26%和2.13%,对照组与EVL组、对照组与序贯组、EVL与序贯组比较,分别为P>0.05、P=0.001和P>0.05;套扎硬化序贯治疗的半年内复发率44.68%,EVL组复发率73.68%,两者比较差异有统计学意义(P=0.021);无论是对照组还是EVL组和序贯治疗组,肝功能CTP C级的再出血、死亡率明显高于A级;MELD模型中,受试者工作特征曲线(ROC)的曲线下面积(AUC)再出血率对照组、序贯组分别为0.944和0.851,死亡率两组分别为0.881和0.984,而复发率EVL组、序贯组分别为0.914和0.765,MELD评分对再出血和死亡的预测具有重要价值。结论套扎硬化序贯治疗能明显降低肝硬化食管曲张静脉患者的再出血率和死亡率,且套扎硬化序贯治疗的复发率要低于单纯套扎。肝功能CTP评分评级和MELD评分对再出血和死亡的预测均具有重要价值,套扎硬化序贯治疗能明显降低CTP为B级和C级静脉曲张的再出血和死亡率,并提高再出血和死亡的MELD阈值。To explore the efficacy of sequential endoscopic variceal ligation plus endoscopicvariceal sclerotheropy and the factors associated with the prognosis.Methods106cases with esophageal varicesin control group was treated with drugs alone;study group had113cases,was given endoscopic therapy add drugs,The study group randomly divided into two groups,one was treated with endoscopic variceal ligation all the time(EVL group),another was treated with sequential endoscopic variceal ligation plus endoscopic variceal sclerotheropy(sequential group).After the treatment,the rate of removal of varicose veins,the rate of rebleeding,the number of total treatment,mortality and intra-operative complications and postoperative complications were compared.Andcompared rebleeding rate and mortality with the control group and study groups with different CTP and MELD,analyze the factors of prognosis,and evaluate their prognostic value.Results Rebleeding,rate in control group,EVLgroup and sequential group were41.51%,10.53%and10.64%,sequential group was significantly better than controlgroup(P=0.000);mortality in control group,EVL group and sequential group were15.09%,5.26%and2.13%,sequential group was also significantly better than control group(P=0.001);rate of recurrence in EVL group andsequential group within half a year were73.68%and44.68%,sequential group was significantly better than EVLgroup(P=0.021).In all control group and EVL group and the sequential group,rebleeding rate and mortality ofthe liver function Child-Turcotte-Pugh(CTP)class C was significantly higher than that of calss A;In MELD model,AUC area under the ROC curve of rebleeding rate in control group and sequential group were0.944and0.851,mortality of the two groups were0.881and0.984,while the rate of recurrence in the EVL group and sequentialgroup were respectively0.914and0.765,the MELD score has the important value to the prediction of rebleedingand death.Conclusion The rebleeding rate and mortality in cirrhotic patients with esophageal varices treated withsequential

关 键 词：套扎硬化序贯治疗 CTP MELD 

分 类 号：R571.3[医药卫生—消化系统]