食管静脉曲张一级预防对首诊原发性肝细胞癌患者预后的影响  

Impact of Primary Prevention of Esophageal Varices on Prognosis of First Diagnosed Primary Hepatocellular Carcinoma

作　　者：罗咏萍[1] 古代娇 陈宗华 刘毅[1] 张键 黄洁 郑学颖 杨志慧 黄亚娜 曹敏[1] 唐欢[1] LUO Yongping;GU Daijiao;CHEN Zonghua;LIU Yi;ZHANG Jian;HUANG Jie;ZHENG Xueying;YANG Zhihui;HUANG Yana;CAO Min;TANG Huan(Department of Gastroenterology,the Second People's Hospital of Yibin City,Yibin,Sichuan 644000,China)

机构地区：[1]宜宾市第二人民医院消化内科

出　　处：《临床误诊误治》2024年第12期31-35,共5页Clinical Misdiagnosis & Mistherapy

基　　金：宜宾市科技计划项目(2021SF002)。

摘　　要：目的探讨内镜下食管静脉套扎术(EVL)作为食管静脉曲张一级预防措施,对原发性肝细胞癌(HCC)患者预后的影响。方法选择2020年1月至2022年12月收治的首诊HCC患者149例,按随机数字表法分为观察组75例和对照组74例。观察组接受EVL治疗,对照组未接受EVL治疗。监测2组患者食管静脉出血和静脉曲张改善情况,并记录随访期间患者的生存情况,采用COX回归分析HCC患者预后不良的影响因素。结果观察组治疗后3、6、12个月食管静脉出血率均显著低于对照组(P<0.05)。观察组食管静脉曲张改善总有效率[76.00%(57/75)]显著高于对照组[59.46%(44/74)](P<0.05)。观察组总病死率[18.67%(14/75)]、因消化道出血病死率[4.00%(3/75)]均显著低于对照组[33.78%(25/74)、16.22%(12/74)](P<0.05)。Kaplan-Meier生存曲线显示,观察组总生存时间显著长于对照组(P<0.05)。多变量COX回归分析显示,EVL是HCC患者预后不良的独立保护因素(HR=0.529,95%CI:0.285,0.865,P<0.05)。结论EVL能显著降低HCC患者食管静脉出血的风险,并改善患者的预后,因此,在临床中EVL治疗可考虑作为HCC患者食管静脉曲张一级预防的首选治疗策略。Objective To explore the effect of endoscopic variceal ligation(EVL)as a primary preventive measure for esophageal varices on the prognosis of patients with primary hepatocellular carcinoma(HCC).Methods A total of 149 pa-tients with HCC treated for the first time from January 2020 to December 2022 were selected and divided into observation group(n=75)and control group(n=74)according to random number table method.The observation group received EVL treat-ment,while the control group did not.The improvement of esophageal venous bleeding and varicose veins in the two groups was monitored,and the survival of the patients during follow-up was recorded.COX regression was used to analyze the influ-encing factors of poor prognosis in HCC patients.Results The rates of esophageal venous bleeding in the observation group at 3,6 and 12 months after treatment were significantly lower than those in the control group(P<0.05).The total effective rate of esophageal varices improvement in the observation group[76.00%(57/75)]was significantly higher than that in the control group[59.46%(44/74)](P<0.05).Total mortality rate[18.67%(14/75)],and mortality rate due to gastrointestinal bleeding[4.00%(3/75)]in the observation group were significantly lower than those in the control group[33.78%(25/74),16.22%(12/74)](P<0.05).Kaplan-Meier survival curve showed that the total survival time of the observation group was significantly lon-ger than that of the control group(P<0.05).Multivariate COX regression analysis showed that EVL was an independent protec-tive factor for poor prognosis of HCC patients(HR=0.529,95%CI:0.285,0.865,P<0.05).Conclusion EVL can significantly reduce the risk of esophageal venous bleeding and improve the prognosis of HCC patients.Therefore,EVL therapy can be con-sidered as the preferred treatment strategy for primary prevention of esophageal varices in HCC patients.

关 键 词：肝肿瘤 食管静脉套扎术 原发性肝细胞癌 食管静脉曲张 预后 一级预防 胃肠出血 

分 类 号：R735.7[医药卫生—肿瘤]