内镜下治疗食管胃底静脉曲张首次破裂出血后近期再出血的危险因素分析  

作　　者：施言 陈数荣 周丹[1] 谢欣城[1] 吴乾能 朱元东 

机构地区：[1]浙江中医药大学附属杭州市西溪医院,310023

出　　处：《浙江临床医学》2021年第10期1457-1459,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省医药卫生科技计划项目(2019KY530)。

摘　　要：目的探讨食管胃底静脉曲张首次破裂出血内镜下治疗后近期再出血的独立危险因素。方法回顾性收集93例食管胃底静脉曲张首次破裂出血患者的临床资料,包括临床表现、血常规、生化功能、Child-Pugh分级、MELD评分、腹水情况,是否合并原发性肝癌(HCC)、门静脉血栓(PVT)、糖尿病,内镜下诊治经过及曲张静脉的形态等,统计早期再出血、早期死亡以及早期发生败血症、肝衰竭的病例,分析内镜治疗后近期再出血的危险因素。结果内镜下治疗后5天内再出血6例(6.4%),危险因素为合并HCC(OR=1.993,95%CI:1.035~3.610)。内镜下治疗后6周内再出血15例(16.1%),危险因素为合并HCC(OR=3.807,95%CI:1.670~9.051)、合并PVT(OR=2.130,95%CI:1.625~4.815)。内镜下治疗后6周内死亡12例(12.9%),均合并HCC,其中MELD评分≥15分者9例。早期死亡的危险因素为合并HCC(OR=3.328,95%CI:1.925~5.636)、MELD评分≥15分(OR=4.602,95%CI:2.612~7.525)。生存分析提示,随着MELD分值逐渐升高,尤其是MELD评分≥15分,患者的死亡风险显著增加。结论肝硬化合并HCC、PVT是首次静脉曲张性出血急诊内镜止血术后近期再出血的独立危险因素,合并HCC和MELD评分≥15分是近期死亡的独立危险因素。Objective To investigate the independent risk factors of recent rebleeding after endoscopic treatment for primary rupture of esophageal and gastric varices.Methods Clinical data of 93 patients with first mptiire and hemorrhage of esophageal and gastric varices were retrospectively collected,including clinical manifestations,blood routine,biochemical flinction,Child-Pugh grade,MELD score,ascites,and whether they were complicated with primary liver cancer(HCC),portal vein thrombosis(PVT),and diabetes,endoscopic diagnosis and treatment,the shape of varicose veins.The cases of early rebleeding,early death,and early sepsis and liver failure were counted.The risk factors for recent rebleeding after endoscopic therapy were analyzed.Results Six patients(6.4%)had further bleeding within 5 days after endoscopic treatment,and the risk factor was complicated with HCC(OR=1.993,95%CI:1.035~3.610).Fifteen patients(16.1%)had further bleeding within 6 weeks after endoscopic treatment.The risk factors were complicated with HCG(OR=3.807,95%CI:1.670~9.051)and complicated with PVT(OR=2.130,95%CI:1.625~4.815).Twelve patients(12.9%)died within 6 weeks after endoscopic treatment,all of whom were complicated with HCC,including 9 patients with MELD scored ≥15 points.The risk factors for early death were combined HCC(OR=3.328,95%CI:1.925~5.636)and MELD scored ≥15 points(OR=4.602,95%CI:2.612~7.525).Survival analysis suggested that the risk of death increased significantly with the gradual increase of MELD score,especially MELD score ≥15 points.Conclusion Liver cirrhosis combined with HCC or PVT are high-risk factors for rebleeding within 6 weeks after emergency endoscopic hemostasis.Combined with HCC or MELD score ≥15 points are high-risk factors for early death after endoscopic treatments of varicose hemorrhage.

关 键 词：食管胃底静脉曲张 内镜下治疗 近期再出血 危险因素 

分 类 号：R73[医药卫生—肿瘤]