超声内镜预测乙型肝炎肝硬化患者食管静脉曲张结扎术后食管静脉曲张复发和出血的作用

摘要/Abstract

摘要： 目的应用超声内镜(EUS)预测乙肝肝硬化(LC)患者食管静脉曲张套扎术(EVL)后复发情况,以有效评估患者预后。方法 2016年1月至2019年9月在濮阳市人民医院行EVL治疗的LC患者116例,其中复发组38例,未复发组78例。比较两组患者的临床资料。计量资料采用t检验;计数资料采用卡方检验;Logistic回归分析探讨EVL复发的影响因素。结果 EVL复发组、未复发组患者Child-Pugh评分分别为(8.5±3.2)分、(6.5±3.0)分,差异有统计学意义(t=8.980,P<0.05);复发组EV程度呈F2、F3为20例(52.6%)、18例(47.4%),未复发组分别为63例(80.8%)、15例(19.2%),差异有统计学意义(χ²=-4.244,P<0.05);复发组、未复发组患者胃静脉曲张分别为27例(71.1%)、33例(42.3%),差异有统计学意义(χ²=8.455,P<0.05)。复发组EV直径、食管旁侧支静脉直径及交通支静脉分别为(10.1±2.5)mm、(9.1±2.4)mm及(3.5±0.6)mm,非复发组分别为(8.2±2.3)mm、(7.0±1.7)mm及(3.0±0.5)mm,差异有统计学意义(t=10.548、10.246、4.405,P<0.05);而两组脾肿大、PLT及交通支数量差异无统计学意义(P>0.05)。将上述有差异的指标纳入多因素分析,结果表明Child-Pugh评分、食管旁侧支静脉直径及交通支静脉最大径是影响EVL复发的独立危险因素(P<0.05),而EV程度、胃静脉曲张及EV直径不是影响EVL复发的独立危险因素(P>0.05)。 EUS诊断EVL复发敏感度、特异度及准确度分别为81.6%、92.3%和88.8%。结论 EUS能够较为准确地预测LC患者EVL术后的复发,对于Child-Pugh评分差、食管旁枝静脉直径及交通支静脉最大径异常的患者需要重视并制定合理治疗策略。

关键词: 超声内镜, 食管静脉曲张套扎术, 乙肝肝硬化, 食管旁侧支静脉

Abstract: Objective Endoscopic ultrasonography (EUS) was used to predict the recurrence of esophageal varices after esophageal variceal ligation (EVL) in patients with hepatitis B liver cirrhosis (LC), so as to effectively evaluate the prognosis of the patients. Methods A total of 116 LC patients treated with EVL from January 2016 to September 2019 were reviewed, including 38 patients with recurrence (29 males and 9 females) and 78 patients without recurrence (52 males and 26 females). T-test was used for measurement data, chi-square test was used for counting data, and Logistic regression analysis was used to explore the influencing factors of EVL recurrence. Results The Child-Pugh scores in EVL recurrent group and non-recurrent group were (8.5±3.2) points and (6.5±3.0) points respectively, and the difference was statistically significant (t=8.980, P<0.05). The EV degrees of F2 and F3 in recurrent group were 20 cases (52.6%) and 18 cases (44.4%), respectively, while those in non-recurrent group were 63 cases (80.8%) and 15 cases (19.2%) respectively, and the difference was statistically significant (χ²=-4.244, P<0.05). The diameters of EV, para-esophageal collateral vein and communicating vein in recurrent group were (10.1±2.5) mm, (9.1±2.4) mm and (3.5±0.6) mm, respectively, compared with those in non-recurrent group [(8.2±2.3) mm, (7.0±1.7) mm and (3.0±0.5) mm], the difference was statistically significant (t=10.548, 10.246, 4.405, P<0.05). There was no significant difference in splenomegaly, PLT and the number of communicating branches between the two groups. The above statistically different indicators were included in multivariate analysis. The results showed that Child-Pugh score, the diameter of para-esophageal collateral vein and the maximum diameter of communicating vein were independent risk factors for the recurrence of EVL, while the degree of EV, gastric varices and EV diameter were not independent risk factors for the recurrence of EVL. The sensitivity, specificity and accuracy of EUS in the diagnosis of EVL recurrence were 81.6% (31/38), 92.3% (72/78) and 88.8% (103/116), respectively. Conclusion EUS could accurately predict the recurrence of LC patients after EVL. For patients with poor Child-Pugh score, abnormal diameter of para-esophageal collateral vein and maximum diameter of communicating vein, it is necessary to pay attention and formulate reasonable treatment strategies.

Key words: Endoscopic ultrasonography, Esophageal variceal ligation, Hepatitis B cirrhosis, Para-esophageal collateral vein

吴菁菁, 董贾中, 王利慧. 超声内镜预测乙型肝炎肝硬化患者食管静脉曲张结扎术后食管静脉曲张复发和出血的作用[J]. 肝脏, 2021, 26(10): 1146-1149.

WU Jing-jing, DONG Jia-zhong, WANG Li-hui. Prediction of recurrence of esophageal varices after esophageal variceal ligation in patients with hepatitis B cirrhosis by endoscopic ultrasonography[J]. Chinese Hepatolgy, 2021, 26(10): 1146-1149.

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