摘要
目的 探讨合并门静脉癌栓(PVTT)的肝细胞癌(HCC)患者经内镜下治疗食管胃静脉曲张出血(EVB)后再出血的危险因素。方法 回顾性分析2008年9月—2016年12月首都医科大学附属北京地坛医院消化内科收治的169例乙型肝炎相关HCC伴PVTT合并EVB经内镜治疗的患者资料,其中47例为PVTTⅡ型,67例为PVTTⅢ型,55例为PVTTⅣ型。比较不同PVTT分型患者的临床指标差异,计量资料多组间比较采用方差分析或Kruskal-Wallis H检验;计数资料组间比较采用χ^(2)检验或校正Fisher检验。采用Kaplan-Meier方法绘制再出血及生存曲线,采用Log-rank检验法比较再出血率和生存率。采用Cox单因素和多因素分析影响患者1年再出血的危险因素。结果 在不同PVTT分型患者的各项临床指标比较中,PVTTⅣ型比PVTTⅡ、Ⅲ型患者的直接胆红素水平更高(Z=6.153,P=0.046)。所有患者经内镜下治疗后均可成功止血,PVTTⅡ型、PVTTⅢ型、PVTTⅣ型患者的半年、1年的再出血率无显著差异,不同分型患者半年、1年、2年、3年的累积生存率无显著差异(P值均>0.05)。Cox多因素分析显示合并肝性脑病(HR=3.643,95%CI:2.099~6.325,P<0.001)、GGT(HR=1.002,95%CI:1.000~1.005,P=0.029)、AFP(HR=1.000,95%CI:1.000~1.000,P=0.002)、肿瘤个数(HR=1.647,95%CI:1.011~2.684,P=0.045)是影响PVTT合并EVB患者内镜治疗后1年内再出血的危险因素。结论 伴有PVTT的HCC患者合并EVB可行内镜下止血治疗,不同PVTT分型的患者再出血率及生存率无显著差异。合并肝性脑病、γ-谷氨酰基移换酶、甲胎蛋白、肿瘤个数是影响PVTT合并EVB患者内镜治疗后1年再出血的独立危险因素。
Objective To analyze the rebleeding rate in hepatocellular carcinoma(HCC) patients with portal vein tumor thrombus(PVTT) after endoscopic treatment of esophagogastric variceal bleeding and then assessed the risk factors of the rebleeding in the patients.MethodsThis study retrospectively recruited 169 hepatitis B-associated HCC patients complicated with PVTT and esophagogastric variceal bleeding treated by endoscopy in Department of Gastroenterology,Beijing Ditan Hospital from September 2008 to December 2016.Among them,47 patients had PVTT Ⅱ,67 patients had PVTT Ⅲ,and 55 patients had PVTT Ⅳ.Their clinicopathological and follow-up data were retrieved from the medical records and statistically analyzed.Continuous data were compared among groups using ANOVA or Kruskal-Wallis H test.Categorial data were compared among groups using Chi-square test or corrected Fisher test.The Kaplan-Meier curves and Log-rank test were performed to analyze the rebleeding rate and cumulative survival rates after treatment.The univariate multivariate Cox regression analyses were used to identify the risk factors affecting the rebleeding of patients.Results Compared with PVTT Ⅱ and Ⅲ,PVTT Ⅳ patients had a higher serum level of the direct bilirubin(Z=6.153,P=0.046).The endoscopy treatment successfully blocked esophagogastric variceal bleeding in all patients.There was no significant difference in the rebleeding rates within six months and a year after the treatment(all P>0.05).It was also no statistically significant difference in cumulative survival rates in six months and l-,2-,and 3-year after the treatment in PVTT Ⅱ,Ⅲ,and Ⅳ patients(all P>0.05).Cox multivariate regression analysis showed that hepatic encephalopathy(HR=3.643,95%CI:2.099-6.325,P<0.001),γ-glutamyltransferase(HR=1.002,95%CI:1.000-1.005,P=0.029),AFP(HR=1.000,95%CI:1.000-1.000,P=0.002) and numbers of tumor lesions(HR=1.647,95%CI:1.011-2.684,P=0.045) were all independent risk factors for 1-year rebleeding in these PVTT patients with esophagogastric variceal
作者
梁秀霞
何玲玲
杨君茹
张福阳
马佳丽
周玉玲
胡居龙
李坪
魏红山
LIANG Xiuxia;HE Lingling;YANG Junru;ZHANG Fuyang;MA Jiali;ZHOU Yuling;HU Julong;LI Ping;WEI Hongshan(Department of Gastroenterology,Beijing Ditan Hospital,The Capital Medical University,Beijing 100015,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2022年第10期2290-2295,共6页
Journal of Clinical Hepatology
基金
国家自然科学基金(82170541)
北京市医院管理中心消化内科学科协同发展中心专项(XXZ0404)
首都医科大学科研培育基金(PYZ20031)。
关键词
癌
肝细胞
门静脉
食管和胃静脉曲张
内窥镜
治疗学
出血
Carcinoma,Hepatocellular
Portal Vein
Esophageal and Gastric Varices
Endoscopes
Therapeutics
Hemorrhage
