直径3mm及以下食管小静脉曲张的临床诊疗经验  

Experience in the Management of Small Esophageal Varices with a diameter of 3 mm and below

作　　者：张晓彬[1] 刘迎娣[1] 王娟[1] 孙国辉[1] 钟立森 何占娣 令狐恩强[1] ZHANG Xiao-bin;LIU Ying-di;WANG Juan;SUN Guo-hui;ZHONG Li-sen;HE Zhan-di;LINGHU En-qiang(Department of Gastroenterology,The First Medical Center of Chinese PLA General Hospital,Fuxing Road NO.28,Haidian District,Beijing,100853,China)

机构地区：[1]解放军总医院第一医学中心消化内科医学部,100853

出　　处：《现代消化及介入诊疗》2023年第9期1074-1079,共6页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：国家重点研发计划(2022YFC2503606)。

摘　　要：目的总结直径3 mm及以下食管小静脉曲张的临床诊疗经验。方法回顾性分析解放军总医院第一医学中心消化内科医学部2007年1月至2023年1月期间收治的直径3 mm及以下食管小静脉曲张患者的临床资料。结果共纳入患者45例,男30例、女15例,平均年龄(53.0±9.98)岁,病因均为肝硬化门静脉高压,其中肝功能Child-Pugh A级36例、Child-Pugh B级9例、Child-Pugh C级0例。所有患者均成功进行了内镜下治疗,氩离子凝固术(APC)治疗组31例、金属夹治疗组14例,中位随访时间32个月。围手术期间,8.9%(4/45)患者术中少量出血,4.4%(2/45)患者术后出现发热,4.4%(2/45)患者术后出现上腹部不适及胸骨后疼痛,2.2%(1/45)患者术后出现进食哽噎,所有患者均未出现死亡等严重并发症。术后1年和2年的食管静脉曲张累积出血率分别为7.3%、11.0%,累积再干预率分别为20.6%、33.4%;而亚组分析提示:金属夹组与APC组比较,术后1年和2年的食管静脉曲张累积出血率则分别为3.2%vs.16.1%、8.1%vs.16.1%,累积再干预率分别为10.7%vs.43.9%、24.1%vs.55.1%,Log-rank检验提示两组之间累积出血率、累积再干预率的差异均不具有统计学意义,P值分别为0.339、0.145。结论APC或金属夹可用于直径3 mm及以下的食管小静脉曲张的治疗,术后并发症发生率、静脉曲张出血率及短期需再干预率低。Objective To summarize the experience in the management of small esophageal varices with a diameter of 3 mm and below.Methods Clinical data of small esophageal varices patients with a diameter of 3 mm and below,who were admitted to the Department of Gastroenterology of the First Medical Center of the PLA General Hospital between January 2007 and January 2023,were analyzed retrospectively.Results A total of 45 patients were enrolled,including 30 males and 15 females,with an average age of(53.0±9.98)years.The etiology were cirrhotic portal hypertension.Based on the liver function,36 patients were Child-Pugh A,9 were Child-Pugh B,while none were Child-Pugh C.All patients received endoscopic interventions successfully,with a median follow-up time of 32 months.31 patients were treated with argon plasma coagulation(APC)and the rest 14 were metal clip.During the perioperative period,8.9%(4/45)of the patients occurred intraoperative bleeding,4.4%(2/45)suffered postoperative fever,4.4%(2/45)had postoperative upper abdominal discomfort and retrosternal pain,2.2%(1/45)experienced postoperative dysphagia,while none of the patients were accompanied with serious complications,such as death.The 1-and 2-year cumulative bleeding rates were 7.3%and 11.0%,re-intervention rates were 20.6%and 33.4%.Subgroup analysis suggested that the 1-and 2-year cumulative bleeding rates in metal clip group and APC group were 3.2%vs.16.1%,8.1%vs.16.1%,and cumulative re-intervention rates were 10.7%vs.43.9%,24.1%vs.55.1%.There were no differences in cumulative bleeding rate and re-intervention rate between the two groups(P-values were 0.339 and 0.145,Log-rank test,respectively).Conclusion APC and metal clip can be applied for the management of small esophageal varices with diameter no more than 3 mm,and the incidence of postoperative complication rate,bleeding rate and re-intervention rate are relatively low.

关 键 词：食管小静脉曲张 氩离子凝固术 金属夹 再干预率 出血率 

分 类 号：R575.2[医药卫生—消化系统]