摘要
目的了解肝硬化门静脉高压症患者行介入断流术后的远期生存率（累计生存率）和累计再出血率及其影响因素。方法回顾性分析61例肝硬化门静脉高压症实施介入断流术患者的临床资料。患者肝功能Child分级，A、B、C级患者分别25、25、11例；食管胃底静脉曲张轻、中、重度分别为10、31、20例；术前有上消化道出血史患者47例。用Kaplan—Meier法分析患者术后的生存率和累计再出血率；用Logrank检验比较不同肝功能分级患者之间以及不同程度食管胃底静脉曲张患者之间生存率的差异；用Cox比例风险模型评价影响患者生存时间的因素。结果患者术后1、3、5、8年生存率分别为94．9％、78．7％、66．0％、35．3％，累计再出血率分别为6．6％、27．7％、44．1％、65．6％，中位生存期为78．6个月。Child A级患者术后1、3、5、8年生存率分别为95．5％、90．9％、77．9％、44．5％；ChildB级分别为96．0％、83．3％、69．5％、45．3％；Child C级术后1、3、5年的生存率分别为90．9％、40．4％、30．3％。ChildC级患者生存率明显低于ChildA级（χ^2=14．1993，P=0．0002）和ChildB级患者（χ^2=9．7887，P=0．0022），而后两者生存率差异无统计学意义（χ^2=0．8664，P=0．352）。轻度食管胃底静脉曲张患者术后1、3、5、8年生存率分别为100．0％、100．0％、100．0％、80．0％；中度曲张患者分别为93．2％、78．5％、61．0％、27．2％；重度曲张患者术后1、3、5年的生存率分别为95．0％、67．1％、53．8％。轻度食管胃底静脉曲张患者生存率明显高于中度曲张患者（χ^2=4．5425，P=0．033）和重度曲张患者（χ^2=5．448，P=0．0196），而后两者生存率差异无统计学意义（χ^2=0．3772，P=0．5391）。术前Child评分≥12分（OR=5．119，P=0．0029）、食管胃底静脉曲张程度（OR=3．291，P=0．0391）和术前末次出血量�
Objective To analyze long-term cumulative survival and re-bleeding rate of cirrhosis patients with portal hypertension after interventional devaseularization and to evaluate long-term efficacy and importance of interventional devaseularization. Methods Sixty-one cirrhosis patients with portal hypertension were retrospectively studied after interventional devaseularization. The number of patients in Child A, B and C was respectively 25, 25 and 11, while that of mild, moderate and severe gastro- esophageal variees was 10, 31 and 20 respectively. Forty-seven patients had gastrointestinal bleeding history. Kaplan-Meier was used to analyze the long-term survival and re-bleeding rates, Log rank test was applied to measure differences in survival among the patients with different degree of hepatic function or gastro-esophageal variees, and Cox regression was used for multivariate analysis of survival, which had statistical significance with P 〈 0. 05. Results The cumulative survivors at 1-, 3-, 5-, 8-year for all the patients after interventional devascularization was 94.9%, 78.7%, 66. 0%, 35.3%, respectively. The cumulative re-bleeding rate at 1-,3-,5-,8-year was 6.6% ,27.7% ,44. 1% ,65.6%, respectively. Median survival time was 78.6 months. When we demixed the patients with hepatic function, we could conclude that the cumulative survival at 1-,3-,5-,8-year for Child A patients was 95. 5% ,90. 9% ,77. 9% ,44. 5%, for Child B was 96.0%, 83.3%, 69. 5%, 45.3%, and at 1-, 3-, 5-year for Child C patients was 90. 9%, 40. 4% ,30. 3%, respectively. Kaplan-Meier survival analysis showed the cumulative survival rate of Child C patients was significantly lower than that of Child A patients （ χ^2 = 14. 1993, P = 0. 0002 ） and Child B patients （χ^2 = 9. 7887, P = 0. 0022）, but there was no significant difference between the latter two groups （ χ^2 = 0. 8664, P = 0. 352 ）. The cumulative survival at 1-, 3-, 5-, 8-year for mild gastro-esophageal varices patients was 100. 0% ,100. 0% ,100. 0% ,80. 0%, and for moderate
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2009年第8期853-857,共5页
Chinese Journal of Radiology
基金
湖北省科技厅科技攻关项目（2003AA304806）
湖北省卫生厅重点科研基金资助项目（JXIA08）
关键词
肝硬化
高血压
门静脉
放射学
介入性
门体分流术
回顾性研究
治疗结果
Liver cirrhosis
Hypertension, portal
Radiology, interventional
Portasystemic shunt
Retrospective studies
Treatment outcome
