规律内镜用于肝硬化食管静脉曲张出血首次行内镜治疗成功后续治疗的价值

摘要/Abstract

摘要： 目的: 研究规律内镜用于肝硬化食管静脉曲张(EV)出血首次行内镜治疗成功后续治疗的价值。方法: 纳入2016年1月至2017年12月于我院收治的146例因肝硬化EV出血首次行内镜治疗成功的患者为对象,按照抽签随机方法分为两组,各73例,其中观察组后续治疗方案选择规律内镜治疗,对照组后续治疗方案选择保守治疗。分析观察组规律内镜治疗及曲张静脉缓解状况,比较两组EV复发、再出血及死亡情况,并对比两组胃静脉曲张出血与并发症发生情况。结果: 观察组持续2～3次规律内镜治疗后EV缓解率为100.0%,显著高于首次治疗后的45.2%(P<0.05);观察组持续2～3次规律内镜治疗后胃静脉曲张消除率较首次治疗后比较差异无统计学意义(P>0.05)。两组1月内EV复发率、再出血率、死亡率比较差异无统计学意义(P>0.05);随访12月内及20月内,观察组EV复发率分别为15.1%、20.5%,显著低于对照组的41.1%、72.6%(P<0.05),再出血率分别为4.1%、13.7%,显著低于对照组的32.9%、56.2%(P<0.05),死亡率分别为0、4.1%,显著低于对照组的8.2%、20.5%(P<0.05)。观察组胃静脉曲张出血发生率为0,显著高于对照组的19.2%(P<0.05);两组上腹部不适、消化道溃疡、发热、胸骨后疼痛发生率比较差异无统计学意义(P>0.05)。结论: 规律内镜在肝硬化EV出血首次行内镜治疗成功后续治疗中具有重要的应用价值,能有效减轻EV程度,消除胃静脉曲张,促使再出血率及死亡率下降,且安全性较好。

关键词: 内镜, 肝硬化, 食管静脉曲张, 出血

Abstract: Objective To study on the value of regular endoscopy as a follow-up treatment after successful primary hemostasis of esophageal variceal (EV) hemorrhage in liver cirrhotic patients. Methods From January 2016 to December 2017, 146 patients with EV hemorrhage due to liver cirrhosis who were successfully treated by endoscopy for the first time in Pingdingshan First People's Hospital were enrolled in this study. They were randomly divided into two groups with 73 cases in each group. The follow-up treatment plan for the observation group was regular endoscopic treatment, while the control group was followed-up with conservative treatment. The remission of varicose vein under regular endoscopic treatment in the observation group were investigated. The recurrence, rebleeding, death due to EV, the occurrence of gastric varicose vein bleeding and related complications in the control and obseration groups were compared. Results The remission rate of EV in the observation group was 100.0% after 2 to 3 times treatment by regular endoscopy, which was significantly higher than 45.2% after the first treatment (P<0.05); There was no significant difference in the elimination rate of gastric varices between the observation group and the control group (P>0.05). There was no significant difference in recurrence rate, rebleeding rate and mortality rate of EV between the two groups within 1 month (P>0.05); During 12 and 20 months of follow-up, EV recurrence rates in the observation group were 15.1% and 20.5%, respectively, which were significantly lower than 41.1% and 72.6% in the control group (P<0.05); rebleeding rates in the observation group were 4.1% and 13.7%, respectively, which were significantly lower than 32.9% and 56.2% in the control group (P<0.05); mortality rates were 0 and 4.1%, respectively, which were significantly lower than 8.2% and 20.5% in the control group (P<0.05). The incidence of gastric varicose bleeding in the observation group was 0, which is significantly lower than 19.2% in the control group (P<0.05); There was no significant difference between these two groups as for the incidences of upper abdominal discomfort, gastrointestinal ulcer, fever and post-sternal pain (P>0.05). Conclusion Regular endoscopy has an important application value in the follow-up of the EV bleeding patients after successful primary endoscopic treatment, which effectively reduces EV degree, eliminates gastric varicose veins, reduces rebleeding rate and mortality with good security.

Key words: Endoscopy, Liver cirrhosis, Esophageal varices, Hemorrhage

王培正, 张威, 王薇, 赵松. 规律内镜用于肝硬化食管静脉曲张出血首次行内镜治疗成功后续治疗的价值[J]. 肝脏, 2020, 25(7): 717-720.

WANG Pei-zheng, ZHANG Wei, WANG Wei, ZHAO Song. The value of regular endoscopy as a follow-up treatment after successful primary hemostasis of esophageal variceal hemorrhage in liver cirrhotic patients[J]. Chinese Hepatolgy, 2020, 25(7): 717-720.

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