肝硬化伴食管静脉曲张破裂出血行脾切除加断流治疗与内镜治疗的疗效对比分析  

Comparative analysis of the therapeutic value of surgical treatment and endoscopic treatment of esophageal variceal bleeding

作　　者：张仕然 陈俊英 胡晓月 陈平 Zhang Shiran;Chen Junying;Hu Xiaoyue;Chen Ping(Department of Hepatobiliary Surgery,Daping Hospital,Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院肝胆外科,重庆400042

出　　处：《腹部外科》2020年第2期144-148,共5页Journal of Abdominal Surgery

摘　　要：目的探讨外科手术治疗(脾切除+门奇静脉断流术)与内镜下治疗(内镜下套扎和硬化剂治疗)对肝硬化所致食管静脉曲张破裂出血的疗效,并寻找导致术后再出血的危险因素。方法回顾性分析陆军军医大学大坪医院2012年1月至2017年11月收治的肝硬化伴食管静脉曲张破裂出血病人的资料。将行脾切除、门奇静脉断流术者纳入外科手术治疗组(54例);将内镜下行套扎、硬化剂治疗者纳入内镜治疗组(63例)。根据搜集所得资料及电话随访结果,统计病人治疗后的再出血率、治疗后再出血的平均间隔时间等。数据采用SPSS(23.0版)软件进行处理。结果手术治疗组术后1、3、5年再出血率分别为9.3%、20.5%、23.1%,内镜治疗组术后1、3、5年再出血率分别为39.7%、73.0%、74.8%,手术治疗组再出血率明显低于内镜治疗组(P<0.001)。COX多因素分析显示:内镜治疗术后再出血的风险是手术治疗的7.2倍(P<0.001)。曲张的食管静脉距门齿的距离、脾脏的大小、脾功能亢进的程度与术后再出血与否无统计学相关性。结论外科手术治疗相比内镜治疗可更好地控制曲张食管静脉的破裂出血,其1、3、5年再出血率明显小于内镜治疗组。治疗方式是病人术后再次出血的危险因素。Objective To study and analyze the efficacy of surgical treatment(splenectomy+azygos vein devascularization)and endoscopic treatment(endoscopic ligation and sclerotherapy)for esophageal variceal bleeding caused by cirrhosis,and to identify the risk factors leading to postoperative rebleeding.Methods The data of patients with liver cirrhosis and esophageal variceal bleeding admitted to the Army Characteristic Medical Center of the Chinese People′s Liberation Army from January 2012 to November 2017 were retrospectively analyzed.Those who underwent splenectomy and azygos vein devascularization were included in the surgical treatment group(54 cases);those who underwent endoscopic band ligation and sclerotherapy were included in the endoscopic treatment group(63 cases).According to the collected data and telephone follow-up results,the rebleeding rate after treatment and the average interval time of rebleeding after treatment were counted.Data were processed using SPSS 23.0 software.Results The rebleeding rate at 1,3,and 5 years after operation was 9.3%,20.5%and 23.1%in the surgery group,and 39.7%,73.0%and 74.8%in the endoscopic group,respectively,and the rebleeding rate was significantly lower in the surgery group(P<0.001).COX multivariate analysis showed that the risk of postoperative rebleeding was 7.2 times higher with endoscopic therapy than with surgical therapy(P<0.001).Conclusion Compared with endoscopic treatment,the surgical treatment can control the esophageal variceal bleeding better and the rebleeding rate was significantly lower.The risk factor of rebleeding is the way of treatment.

关 键 词：肝硬化 食管胃静脉曲张 内镜下静脉曲张套扎术 脾切除 门奇静脉断流 

分 类 号：R575.2[医药卫生—消化系统]