内镜根除治疗食管静脉曲张后复发的相关因素分析

doi:10.3969/j.issn.1672-5069.2014.03.015

摘要/Abstract

摘要： 目的探讨食管静脉曲张（EV）经内镜下套扎序贯硬化（EVLS）根除治疗后影响复发的因素。方法对61例食管静脉曲张患者行EVLS治疗达到根除标准后随访2年,依据复发时间分为高危组（24月内复发）与低危组（24月内未复发）,收集食管静脉曲张经内镜治疗达到根除标准时患者的生化及随访期间的临床资料进行统计学分析。结果2年内食管静脉曲张复发24例（39.3%）,未复发37例（60.7%）;高危组与低危组在出血、脾功能亢进、糖尿病和中/重度腹水的发生率以及Child-Pugh评分、血清白蛋白、血小板计数、凝血酶原时间和超声测量门静脉直径等方面差异有统计学意义（P均<0.05）;进一步行非条件Logistic回归分析显示出血史、中/重度腹水和糖尿病病史（OR值分别为9.7,6.5和10.8）是食管静脉曲张复发的独立危险因素。结论出血、中/重度腹水、糖尿病是食管静脉曲张复发的独立危险因素,对该类患者应积极随访和再治疗。

关键词: 食管静脉曲张, 内镜根除治疗, 复发, 危险因素

Abstract: ObjectiveTo investigate the recurrence factors for esophageal varices after endoscopic eradication therapy of endoscopic sequential variceal ligation plus sclerotherapy（EVLS）. MethodsSixty-one patients with esophageal varices achieved eradication standards after EVLS therapy were followed up for 2 years. The patients were divided into high recurrence risk group （relapse within 24 months） and low recurrence risk group （without recurrence within 24 months） according to the recurrence time,and the biochemical and clinical data of the two groups were collected and analyzed statistically. Results There were 24（39.3%） cases of patients diagnosed with esophageal variceal recurrence within two years,and 37（60.7%）without recurrence. There were significant differences between the two groups as respect to bleeding history,spleen hyperthyroidism,diabetes,moderate/severe ascites, Child-Push scores,serum albumin,platelet counts,prothrombin time and portal vein diameters measured by ultrasound（P<0.05）;Furthermore,non-conditional logistic regression analysis showed that bleeding history,moderate/severe ascites and diabetes history were independent risk factors for esophageal varices recurrence（OR value 9.7,6.5 and 10.8,respectively）. Conclusions Bleeding history,moderate/severe ascites and diabetes history are independent risk factors for esophageal varices recurrence and these patients should be actively followed up and retreated in time.

Key words: Esophageal varices, Endoscopic eradication therapy, Relapse, Risk factors

周洋, 王要军. 内镜根除治疗食管静脉曲张后复发的相关因素分析[J]. 实用肝脏病杂志, 2014, 17(3): 279-283.

Zhou Yang, Wang Yaojun. Recurrence factors for esophageal varices after endoscopic eradication therapy[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2014, 17(3): 279-283.

参考文献

[1] Yoshida H,Mamada Y,Tanial N,et al. Treatment modalities for bleeding esophagogastric varices. J Nippon Med Sch,2012,79（1）：19-30.
[2] 张鸿,严冬梅,范合璋,等.内镜下曲张静脉套扎治疗食管静脉重度曲张患者60例. 实用肝脏病杂志,2013,16（4）:330-331.
[3] 李弼民,朱萱,舒徐,等. 肝硬化食管静脉曲张破裂出血序贯治疗的临床应用价值. 中华消化内镜杂志,2013,30（2）:67-70.
[4] 尚瑞莲,李兆申,金震东,等. 小剂量硬化剂加固对食管静脉曲张术后的影响. 实用肝脏病杂志,2009,12（3）:207-209.
[5] 中华医学会消化内镜学分会食管胃静脉曲张学组,消化道静脉曲张及出血的内镜诊断和治疗规范试行方案（2009年）. 中华消化内镜杂志,2010,27（1）:1-4.
[6] 朱春兰,徐晓红,张国梁,等. 影响食管静脉曲张套扎术疗效的相关因素分析. 中华消化内镜杂志,2004,21（3）:157-159.
[7] Altintas E,Sezgin O,Kacar S,et al. Esophageal variceal ligation for acute variceal bleeding:results of three years follow-up. Turk J Gastroenterol,2004,15（1）:27-33.
[8] Azam Z,Hamid S,Jafri W,et al. Short course adjuvant terlipressin in acute variceal bleeding:a randomized double blind dummy controlled trial. J Hepatol,2012,56（4）：819-824.
[9] Rahimi RS,Rockey DC. Complications and outcomes in chronic liver disease. Curr Opin Gastroententerol,2011,27（3）：204-209.
[10] Garcia-Tsao G,Bosch J. Management of varices and variceal hemorrhage in cirrhosis.N Engl J Med,2010,362（9）:823-832.
[11] Lo GH,Chen WC,Wang HM,et al. Controlled trial of ligation plus nadolol versus nadolol alone for the prevention of first variceal bleeding. Hepatology,2010,52（1）:230-237.
[12] Sanyal AJ,Bosch J,Blei A,et a1. Ponal hypertension and its complications. Gastroentcrology,2008,134（6）：1715-1728.
[13] Garcia-Tsao G,Sanyal AJ,Grace ND et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology,2007,46（3）:922-938.
[14] Xu L,Ji F,Xu QW,et al. Risk factors for predicting early variceal rebleeding after endoscopic variceal ligation. World J Gastroenterol,2011,17（28）: 3347-3352.
[15] Nishida T,Tsuji S,Tsujii M,et al.Oral glucose tolerance test predicts prognosis of patients with liver cirrhosis. Am J Gastroenterol,2006,101（1）:70-75.
[16] Sempere L,Palazón JM,Sánchez-Payá J,et al.Assessing the short-and long-term prognosis of patients with cirrhosis and acute variceal bleeding. Rev Esp Enferm Dig,2009,101（4）:236-248.
[17] 辛克锋,李铭,代莉,等. 乙型肝炎肝硬化患者血清-腹水白蛋白梯度与食管静脉曲张程度的关系.实用肝脏病杂志,2010,13（5）:377-378.
[18] 郭银燕. 血小板计数与脾大小之比、血清-腹水白蛋白梯度与肝硬化食管静脉曲张的关系. 北京医学,2010,32（1）:16-18.
[19] Ou MC,Chuang MT,Lin XZ,et al. A novel method for the angiographic estimation of the percentage of spleen volume embolized during partial splenic embolization. Eur J Radiol,2013,82（8）:1260-1265.
[20] Senjyu S,Nishida H,Sakamoto M,et al. Endoscopic color Doppler ultrasonographic evaluation of recurrent esophagogastric varices following endoscopic injection sclerotherapy. Hepatol Res,2003,26（3）:174-180.