胃镜下硬化术联合组织胶注射术治疗乙型肝炎肝硬化并发食管胃静脉曲张破裂出血患者1年再出血危险因素分析  

Risk factors of re-bleeding in patients with hepatitis B cirrhosis and esophagogastric varices bleeding within one year after gastroscopic sclerotherapy and tissue glue injection

作　　者：杨帆 张小娟 李丹 姜莎莎 张亮 唐伟 赵微 Yang Fan;Zhang Xiaojuan;Li Dan(Department of Gastroenterology,Second People's Hospital,Jiangyou 621700,Sichuan Province,China)

机构地区：[1]四川省江油市第二人民医院消化内科,621700 [2]四川省江油市第二人民医院肿瘤科,621700 [3]成都医学院附属医院消化内科

出　　处：《实用肝脏病杂志》2023年第6期875-878,共4页Journal of Practical Hepatology

基　　金：四川省卫生健康委员会科研项目(编号:20PJ271)。

摘　　要：目的探讨乙型肝炎肝硬化并发食管胃静脉曲张破裂出血(EGVB)患者经胃镜下硬化术联合组织胶注射术治疗后1年内再出血的危险因素。方法2016年6月~2021年3月我院诊治的乙型肝炎肝硬化并发EGVB者137例,采用胃镜下硬化术联合组织胶注射术治疗,随访1年,观察患者术后再出血情况,应用Logistic回归分析术后1年再出血的危险因素。结果137例肝硬化并发EGVB患者死亡28例(20.4%);对生存的109例患者随访1年,发生治疗后再出血者42例(30.7%);再出血组与未再出血组在Child-Pugh分级(P=0.001)、食管静脉曲张程度(P=0.027)、腹水量(P=0.016)和营养不良(P=0.009)方面差异具有统计学意义(P<0.05);Logistic回归分析显示Child-Pugh分级差(OR=1.863)、食管静脉曲张严重(OR=2.028)、腹水量大(OR=1.797)和中重度营养不良(OR=1.589)是术后1年内再出血发生的独立危险因素。结论肝硬化并发EGVB患者在接受内镜下治疗后存在再出血的风险,熟悉这些危险因素并及时给予补救治疗或许能提高患者生存率。Objective The aim of this study was to investigate the risk factors of re-bleeding in hepatitis B viral infection-induced liver cirrhosis(LC)complicated with esophagogastric varices bleeding(EGVB)within 1 year after gastroscopic sclerotherapy and tissue glue injection therapy.Methods A total of 137 patients with hepatitis B LC and EGVB were enrolled in our hospital between June 2016 and March 2021,and all patients underwent gastroscopic sclerotherapy and tissue glue injection therapy.They were all followed-up for 1 year to observe the occurrence of postoperative re-bleeding.The risk factors of re-bleeding were analyzed by multivariate Logistic regression analysis.Results Among the 137 patients with cirrhosis and EGVB,28 patients(20.4%)died of emergent bleeding;out of the 109 survivals within 1 year of follow-up,the postoperative re-bleeding occurred in 42 cases(30.7%);there were significant differences between patients with re-bleeding and without re-bleeding as respect to Child-Pugh class(P=0.001),severity of esophageal varices(P=0.027),ascites volume(P=0.016)and malnutrition(P=0.009,P<0.05);the Logistic regression analysis showed that poor Child-Pugh class(OR=1.863),severe esophageal varices(OR=2.028),large volume of ascites(OR=1.797)and moderate to severe malnutrition(OR=1.589)were the independent risk factors for re-bleeding within 1 year after endoscopic therapy.Conclusion The patients with hepatitis B LC and EGVB after gastroscopic therapy could have high risk for re-bleeding within one year,and the careful intervention to these risk factors might decrease the incidence of re-bleeding and increase the survival rates of them.

关 键 词：肝硬化 食管胃静脉曲张破裂出血 硬化剂注射 组织胶注射 再出血 危险因素 

分 类 号：R575.2[医药卫生—消化系统] R512.62[医药卫生—内科学]