食管静脉曲张首次套扎术后早期再出血的危险因素分析

崔璨璨; 李丹丹; 李长锋; 闫振坤; 王丽强; 孙晨; 张克; 张斌

doi:10.3969/j.issn.1001-5256.2018.07.017

食管静脉曲张首次套扎术后早期再出血的危险因素分析

DOI: 10.3969/j.issn.1001-5256.2018.07.017

吉林大学中日联谊医院胃肠内科(内镜中心)

基金项目:

吉林省科技发展计划基金(sczsy201606)；

详细信息

中图分类号: R657.3
计量
- 文章访问数: 2309
- HTML全文浏览量: 66
- PDF下载量: 388
- 被引次数: 0
出版历程
- 收稿日期: 2018-01-17
- 出版日期: 2018-07-20

Risk factors for early rebleeding after first-time endoscopic variceal ligation

China-Japan Union Hospital of Jilin University

Research funding:

摘要

摘要: 目的探讨首次食管静脉曲张套扎（EVL）对肝硬化患者肝功能的影响及术后早期再出血的危险因素。方法收集2013年12月-2016年12月于吉林大学中日联谊医院接受EVL治疗的125例肝硬化食管静脉曲张患者临床资料。所有患者按照不同肝功能Child-Pugh评分进行分级,观察EVL手术前与术后1周的肝功能情况,分析EVL术后早期再出血患者的特点。符合正态分布的计量资料2组间比较采用t检验,多组间比较采用单因素方差分析;非正态分布的计量资料比较采用Wilcoxon检验。计数资料组间比较采用χ2检验。采用Cox回归风险模型分析术后出血的危险因素,Kaplan-Meier曲线分析各观察指标与术后出血的关系,log-rank检验其差异。结果不同Child-Pugh分级患者EVL治疗前后肝功能指标差异均无统计学意义（P值均>0.05）。125例患者中11例发生早期再出血,早期再出血率为8.8%。Cox单因素分析结果显示,出血患者与未出血患者术前血红蛋白、PT、AST、TBil、Alb、有无门静脉血栓、腹水量及肝功能分级比较,差异均有统计学意义（P值均<0.05）;多因...
- 食管和胃静脉曲张 /
- 肝硬化 /
- 结扎术 /
- 手术后出血 /
- 危险因素
Abstract: Objective To investigate the effect of endoscopic variceal ligation ( EVL) for the first time on liver function in patients with liver cirrhosis and the risk factors for early rebleeding after surgery. Methods A retrospective analysis was performed for the clinical data of 125 cirrhotic patients with esophageal varices who underwent EVL in China-Japan Union Hospital of Jilin University from December 2013 to December 2016. They were divided into different groups according to Child-Pugh score. Liver function was observed before EVL and at 1 week after EVL. The features of patients who experienced early rebleeding after EVL were analyzed. The t-test was used for comparison of normally distributed continuous data between two groups, and a one-way analysis of variance was used for comparison between multiple groups; the Wilcoxon test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test was used for comparison of categorical data between groups. The Cox regression model was used to analyze the risk factors for postoperative bleeding, the Kaplan-Meier curve was used to analyze the association of observation indices with postoperative bleeding, and the log-rank test was used for difference analysis. Results There were no significant differences in liver function parameters between the patients with different Child-Pugh classes before and after EVL ( all P > 0. 05) . Of all 125 patients, 11 experienced early rebleeding, resulting in an early rebleeding rate of8. 8%. The univariate Cox regression analysis showed that there were significant differences in hemoglobin, prothrombin time ( PT) , aspartate aminotransferase, total bilirubin, albumin, the presence or absence of portal vein thrombosis, amount of ascites, and liver function classification between the patients with bleeding and those without ( all P < 0. 05) . The multivariate Cox regression analysis showed that Child-Pugh class C ( hazard ratio [HR]= 6. 363, 95% confidence interval [CI]: 1. 629-26. 580, P = 0. 021) , amount of ascites ( small: HR = 6. 581, 95% CI: 1. 060-66. 681, P = 0. 046; middle/large: HR = 8. 447, 95% CI: 1. 763-11. 641, P = 0. 022) , long PT before surgery ( HR =1. 146, 95% CI: 1. 039-1. 264, P = 0. 006) , and the presence of portal vein thrombosis ( HR = 9. 691, 95% CI: 1. 185-19. 281, P = 0. 034) were independent risk factors for early rebleeding after EVL. The Kaplan-Meier curve analysis was performed for the results of the multivariate Cox regression analysis, and the results showed that Child-Pugh class C ( χ2= 3. 972, P = 0. 046) , presence of ascites ( χ2= 20. 916, P <0. 001) , prolonged PT ( χ2= 21. 302, P < 0. 001) , and presence of portal vein thrombosis ( χ2= 10. 608, P = 0. 001) were risk factors for early rebleeding after EVL. Conclusion EVL does not cause damage to patients' liver function within a short period of time and is safe and effective. Liver function should be corrected, the amount of ascites should be reduced, and coagulation function should be improved before surgery to reduce the incidence rate of early rebleeding after EVL.
- esophageal and gastric varices /
- liver cirrhosis /
- ligation /
- postoperative hemorrhage /
- risk factors

HTML全文

参考文献(19)

[1]JIN Y, WANG X, ZHANG LJ, et al.Risk factors for early rebleeding after esophageal variceal ligation in patients with liver cirrhosis[J].J Clin Hepatol, 2017, 33 (11) :2147-2151. (in Chinese) 金燕, 王雪, 张玲娟, 等.肝硬化患者食管静脉曲张套扎术后早期再出血的危险因素分析[J].临床肝胆病杂志, 2017, 33 (11) :2147-2151.

[2]MAO P, XIANG YL.Cause of early and late rebleeding after endoscopic variceal ligation and the nursing[J].China J Endosc, 2013, 19 (7) :732-735. (in Chinese) 毛平, 向亚利.内镜下套扎治疗食管静脉曲张术后早、晚期再出血的原因分析及处理[J].中国内镜杂志, 2013, 19 (7) :732-735.

[3] Esophageal and Gastric Varices Group, Chinese Society of Endoscopy, Chinese Medical Association.Tentative guidelines for endoscopic diagnosis and treatment of varicosity and variceal bleeding in digestive tract (2009) [J].Chin J Dig Endosc, 2010, 27 (1) :1-4. (in Chinese) 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) [J].中华消化内镜杂志, 2010, 27 (1) :1-4.

[4]LU ZY, ZHONG NS.Internal Medicine[M].7th ed.Beijing:People's Medical Publishing House, 2008:453. (in Chinese) 陆再英, 钟南山.内科学[M].第7版.北京:人民卫生出版社, 2008:453.

[5]de FRANCHIS R, Baveno VI Faculty.Expanding consensus in portal hypertension:Report of the Baveno VI Consensus Workshop:Stratifying risk and individualizing care for portal hypertension[J].J Hepatol, 2015, 63 (3) :743-752.

[6]HERRERA JL.Management of acute variceal bleeding[J].Clin Liver Dis, 2014, 18 (2) :347-357.

[7]YANG ZF, ZHAO Q, WANG XY, et al.Portal venous flow before and after esophageal variceal ligation[J].Chin J Dig Endosc, 2004, 21 (3) :184-185. (in Chinese) 杨占凤, 赵群, 王晓燕, 等.食管静脉曲张套扎术前后门静脉血流的研究[J].中华消化内镜杂志, 2004, 21 (3) :184-185.

[8]SHEVCHENKO IUL, OBUKHOVSKIIBI, IAKOVENKO AV.The clinical course of portal hypertensive gastropathy after ligation of esophageal varicose veins[J].Klin Med (Mosk) , 2007, 85 (5) :47-51.

[9]VUACHET D, CERVONI JP, VUITTON L, et al.Improved survival of cirrhotic patients with variceal bleeding over the decade 2000-2010[J].Clin Res Hepatol Gastroenterol, 2015, 39 (1) :59-67.

[10]ZHOU JN, WEI Z, SUN ZQ.Risk factors for early rebleeding after esophageal variceal ligation in patients with liver cirrhosis[J].Chin J Hepatol, 2016, 24 (7) :486-492. (in Chinese) 周嘉宁, 魏志, 孙自勤.肝硬化食管静脉曲张套扎后早期再出血相关危险因素的多中心研究[J].中华肝脏病杂志, 2016, 24 (7) :486-492.

[11]WANG Z, LUO XF, LI X.Risk factors for early rebleeding after elective endoscopic variceal ligation (EVL) and long-term outcome:A retrospective analysis[J].Chin J Dig Endosc, 2013, 30 (12) :668-670. (in Chinese) 王竹, 罗薛峰, 李肖.食管静脉曲张择期内镜下套扎术后早期再出血及远期预后的回顾性分析[J].中华消化内镜杂志, 2013, 30 (12) :668-670.

[12]PROCOPETB, TANTAU M, BUREAU C.Are there any alternative methods to hepatic venous pressure gradient in portal hypertension assessment?[J].J Gastrointestin Liver Dis, 2013, 22 (1) :73-78.

[13]XU L, JI F, XU QW, et al.Risk factors for predicting early variceal rebleeding after endoscopic variceal ligation[J].World J Gastroenterol, 2011, 17 (28) :3347-3352.

[14]GROTHAUS J, PETRASCH F, ZEYNALOVA S, et al.Risk factors for bleeding complications after endoscopic variceal ligation therapy[J].Z Gastroenterol, 2010, 48 (10) :1200-1206.

[15]PENG Y, QI XS, GUO XZ.Recommendations for consensus statement by the Italian Association for the Study of Liver Diseases (AISF) and the Italian Society of Internal Medicine (SIMI) :Hemostatic balance in patients with liver cirrhosis[J].J Clin Hepatol, 2016, 32 (6) :1052-1053. (in Chinese) 彭颖, 祁兴顺, 郭晓钟.《2016年意大利肝病学会和意大利医学学会共识:肝硬化止血平衡》推荐意见[J].临床肝胆病杂志, 2016, 32 (6) :1052-1053.

[16]LATA J, HUSOVAL, JURANKOVAJ, et al.Factors participating in the development and mortality of variceal bleeding in portal hypertension-possible effects of the kidney damage and malnutrition[J].Hepatogastroenterology, 2006, 53 (69) :420-425.

[17]DELL'ERA A, IANNUZZI F, FABRIS FM, et al.Impact of portal vein thrombosis on the efficacy of endoscopic variceal band ligation[J].Dig Liver Dis, 2014, 46 (2) :152-156.

[18]SENZOLO M, M SARTORI T, ROSSETTO V, et al.Prospective evaluation of anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis[J].Liver Int, 2012, 32 (6) :919-927.

[19]LIU B, FANG ZY, MENG DM.Progress of prevention and treatment of complications of liver cirrhosis[J].J Chin Pract Diagn Ther, 2016, 30 (12) :1152-1155. (in Chinese) 刘斌, 方正亚, 孟冬梅.肝硬化并发症治疗及预防研究进展[J].中华实用诊断与治疗杂志, 2016, 30 (12) :1152-1155.

施引文献

资源附件(0)

访问统计