摘要
目的观察内镜下食管静脉曲张套扎术(EVL)治疗肝硬化食管静脉曲张破裂出血(EVB)的临床疗效。方法收集2010年12月-2013年7月广东医科大学附属深圳市第三人民医院收治的肝硬化EVB患者84例,随机分为套扎组(A组,应用EVL联合生长抑素、埃索美拉唑治疗)、对照组(B组,应用生长抑素、埃索美拉唑治疗),每组42例。观察2组止血率、再出血率、并发症发生率、病死率等,了解EVL后静脉曲张根除率、早期再出血相关危险因素。符合正态分布的计量资料2组间比较采用t检验,多组间比较采用方差分析;不符合正态分布的计量资料2组间比较采用Mann-Whitney U检验,组内两两比较采用Wilcoxn符号秩和检验,多组间比较采用Kruskal-Wallis H检验。计数资料组间比较采用χ~2检验或Fisher确切概率法。生存率的计算采用KaplanMeier法,比较不同组别的生存情况采用log-rank检验。二分类资料的影响因素分析采用logistic回归方法。结果 A、B 2组止血率分别为97.62%、80.95%,差异有统计学意义(P=0.029)。A组1年~2年(15.38%vs 38.89%,χ~2=5.323,P=0.021)、2~3年(15.38%vs 48.48%,χ~2=10.448,P=0.001)再出血率均低于B组。A组14例(33.33%)有不良反应,B组7例(16.67%)有不良反应。A组3年内死亡4例,B组3年内死亡9例。A组治疗后1周的ALT、AST水平较治疗前1周明显改善(Z值分别为-2.177、-2.044,P值分别为0.029、0.041),2组治疗后1周的PTA、PT、国际标准化比值(INR)、Alb均较治疗前1周明显改善(A组:Z=-4.007,t=3.866,Z=-4.152,t=-4.623,P值均<0.001;B组:t=-5.069,Z=-3.870,Z=-3.909,Z=-5.245,P值均<0.001),2组治疗后1周的PTA水平比较差异有统计学(Z=-3.902,P<0.001)。A组EV总消失率为85.71%,复发率为14.29%,肝功能分级与门静脉内径之间有明显关系(F=3.319,P=0.047)。入院症状、住院天数、Child-Pugh分级、合并自发性腹膜炎、门静脉内径、PT、INR、ALT是套扎后早期再出血危险因素(P值均<0.05)。结论 E
Objective To investigate the clinical effect of endoscopic esophageal variceal ligation （EVL）in the treatment of esophageal variceal bleeding （EVB）in patients with liver cirrhosis.Methods A total of 84 liver cirrhosis patients with EVB who were admitted to The Third People′s Hospital of Shenzhen,Guangdong Medical University,from December 2010 to July 2013 were divided into ligation group （group A,treated with EVL combined with somatostatin and esomeprazole）and control group （group B,treated with somatostatin and es-omeprazole）,with 42 patients in each group.The hemostasis rate,rebleeding rate,incidence rate of complications,and mortality rate were observed in both groups,as well as the variceal eradication rate after EVL and risk factors for early rebleeding.The t -test was used for com-parison of normally distributed continuous data between two groups,and an analysis of variance was used for comparison between multiple groups;the Mann -Whitney U test was used for comparison of non -normally distributed continuous data between two groups,the Wilcoxon signed -rank sum test was used for comparison within each group,and the Kruskal -Wallis H test was used for comparison between multiple groups.The chi -square test or Fisher′s exact test was used for comparison of categorical data between groups.The Kaplan -Meier method was used to calculate survival rates,and the log -rank test was used to compare survival rates between groups.The logistic regression meth-od was used to investigate the influencing factors for dichotomous data.Results There was a significant difference in the hemostasis rate be-tween groups A and B （97.62% vs 80.95%,P =0.029）.Compared with group B,group A had significantly lower rebleeding rates in 1 -2 years （15.38% vs 38.89%,χ2 =5.323,P =0.021）and 2 -3 years （15.38% vs 48.48%,χ2 =10.448,P =0.001）.A total of 14 patients （33.33%）in group A and 7 patients （16.67%）in group B experienced adverse events,and 4 patients in group A and 9 patients in group B died wit
作者
张东旭
骆子义
ZHANG Dongxu LUO Ziyi.(Department of Gastroenterology, The Third People＇ s Hospital of Shenzhen, Guangdong Medical University, Shenzhen, Guangdong 518020, China)
出处
《临床肝胆病杂志》
CAS
2017年第1期76-81,共6页
Journal of Clinical Hepatology
关键词
肝硬化
结扎术
食管和胃静脉曲张
治疗结果
liver cirrhosis
ligation
esophageal and gastric varices
treatment outcome
