肝癌合并食管胃静脉曲张出血的临床诊断

摘要/Abstract

摘要： 目的探讨肝癌合并食管胃静脉曲张出血(GEVH)的临床特点,以及内镜按需治疗的有效性、安全性。方法回顾分析2013年1月至2023年12月间上海交通大学医学院附属瑞金医院消化内科40例肝癌合并食管胃静脉曲张出血患者的临床特点、内镜按需治疗效果和治疗后转归情况。结果 40例患者中,多数肝脏储备功能较差,其中Child-Turcotte-Pugh评分B级和C级的患者36例(90.0%)。首次出血的病情较重,呕血患者31例(77.5%)。首次内镜按需治疗以内镜下曲张静脉套扎术(EVL)为主,为33例(82.5%),内镜治疗后患者的出血症状均得到控制,22例患者在首次内镜治疗后继续随访复查,平均随访37个月,末次复查时有再出血症状3例,随访期间未出现严重的并发症。结论内镜下诊断及按需治疗肝癌伴食管胃静脉曲张出血有效且安全,可延长患者生存时间,提高生存质量。

关键词: 食管胃静脉曲张出血, 肝癌, 内镜治疗

Abstract: Objective To investigate the clinical characteristics and diagnosis of gastroesophageal variceal hemorrhage (GEVH) of patients with hepatocellular carcinoma (HCC), and to evaluate the efficacy and safety of patient-oriented endoscopic therapy for GEVH. Methods The clinical characteristics, patient-oriented endoscopic therapy efficacy, and prognosis of 40 HCC patients with GEVH from the Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between January 2013 and December 2023 were retrospectively studied. Results Most of the patients (38/40) had a poor liver function, among which 90.0% of the patients were Child-Turcotte-Pugh grade B and C, and most patients were with severe initial bleeding. 77.5% of the patients had hematemesis. The initial patient-oriented endoscopic therapy was mainly endoscopic variceal ligation (EVL) (82.5%), and the patients′ bleeding symptoms were all controlled after endoscopic therapy. Twenty-two patients continued the follow-ups after the first endoscopic therapy, with an average follow-up duration of 37 months. Only 3 patients had rebleeding symptoms at the last follow-up, without serious complications during the follow-ups. Conclusion Endoscopic diagnosis and patient-oriented endoscopic therapy for HCC with GEVH are effective and safe, which may prolong the patients’ survival and improve the patients’ quality of life.

Key words: Gastroesophageal variceal hemorrhage, Hepatocellular carcinoma, Endoscopic therapy

谷雷雷, 陈平, 吴云林. 肝癌合并食管胃静脉曲张出血的临床诊断[J]. 肝脏, 2025, 30(11): 1475-1477.

GU Lei-lei, CHEN Ping, WU Yun-lin. Clinical diagnosis of hepatocellular carcinoma complicated with esophageal and gastric variceal bleeding[J]. Chinese Hepatolgy, 2025, 30(11): 1475-1477.

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