内镜下套扎术治疗肝硬化食管静脉曲张的疗效及术后再出血的危险因素分析

摘要

目的：观察内镜下套扎术作为二级预防在肝硬化食管静脉曲张患者中应用的有效性，并研究套扎术后再出血的危险因素。方法回顾性分析2000年－2012年北京大学第一医院肝硬化合并食管静脉曲张破裂出血（EVB）的患者资料，选择行套扎治疗的患者作为套扎组，行内科保守治疗的患者作为对照组，对两组患者预后情况进行随访观察。在套扎组中，按照套扎术后是否发生再次出血分为再出血组和未再出血组，对其临床资料进行对比分析。计量资料组间比较采用独立样本t检验，必要时进行数据转换后的t检验，等级资料采用Mann－Whitney U检验；计数资料组间比较采用χ2检验。结果共有139例患者纳入分析，其中套扎组119例，对照组20例，随访时间为1～24个月。随访结束时，套扎组的再出血率、早期再出血率和病死率分别为41．2％、8．4％、7.6％，对照组分别为70．0％、20．0％、40．0％，两组差异具有统计学意义（P值均＜0．05）。在套扎组中，对再出血组和未再出血组患者的临床资料进行对比分析发现，肝性脑病病史、腹水、Child－Pugh分值、血小板水平等因素在两组间差异具有统计学意义（P值均＜0.05）。结论内镜套扎术作为二级预防能够有效改善肝硬化合并EVB患者的预后。肝功能的恶化可能预示着再出血风险增高，因此，在套扎治疗的同时，改善患者基础情况对于再出血的预防具有重要意义。%Objective To examine the efficacy of endoscopic variceal ligation (EVL)as a secondary prophylaxis for cirrhotic patients asso-ciated with esophageal varices,and to identify the risk factors for postoperative rebleeding.Methods A retrospective analysis was per-formed on the clinical data of cirrhotic patients with esophageal variceal bleeding (EVB)in the Peking University First Hospital from 2000 to 2012.Patients were divided into ligation and control (conservative treatment)groups and their prognosis was followed up.According to the outcome,the ligation group was further divided into rebleeding and non-rebleeding groups for comparative analysis of clinical data.Contin-uous data were compared between groups using the independent samples t-test,and data were converted before t-test when necessary. Ranked data were analyzed using the Mann-Whitney U test,and categorical data were compared between groups using the χ2 test.Results A total of 139 patients were enrolled,1 19 assigned to the ligation group and 20 to the control group.At the end of the follow-up period (1 to 24 months),the rebleeding,early rebleeding,and mortality rates significantly differed between the ligation and control groups (P<0.05),i.e.,41.2%,8.4%and 7.6%in the ligation group versus 70.0%,20.0%and 40.0%in the control group,respectively.In the ligation group,comparative analysis showed that the history of hepatic encephalopathy,ascites,Child-Pugh score,and platelet count sig-nificantly differed between the rebleeding and non-rebleeding groups (P<0.05).Conclusion As a secondary prophylaxis therapy,EVL can effectively improve the prognosis of cirrhosis associated with EVB.The deterioration of liver function may indicate a higher risk of re-bleeding.Therefore,it is necessary to improve patients basic conditions during EVL therapy.