影响食管静脉曲张套扎术疗效的相关因素分析

Analysis of the relevant factors affecting the result of endoscopic variceal ligation

目的 探讨影响食管静脉曲张套扎术(EVL)疗效的相关因素。方法 对520例肝硬化食管静脉曲张出血(EVB)采用密集结扎法行EVL,其中肝硬化组332例,合并肝癌组70例,肝硬化断流术后组118例。比较各组EVL疗效并观察各种相关因素对EVL疗效的影响。结果 3组EVL后食管静脉曲张(EV)消失率依次分别为42.2％、27.1％、89.8％;EV复发率24.1％、42.9％、8.5％;近期再出血率3.0％、21.4％、4.2％;远期再出血率12.0％、20.0％、3.4％。肝硬化合并肝癌组近期再出血率明显高于肝硬化组(P<0.05)。断流术后组与肝硬化组比较,前者EV消失率高、复发率低(P<0.05)。EVL术前肝功能越差,EV复发、EVB再发率越高(P<0.01)。EVL术后服用普萘洛尔组EV复发率、EVB再发率低,存活率高(P<0.01)。EV复发组胃左静脉径增宽、血流速度快,且绝大部分为离肝血流。结论 EVL是治疗EVB安全、有效的首选方法,其疗效受诸多相关因素影响。

Objective To study the relevant factors affecting the result of endoscopic variceal liga-tion ( EVL). Methods EVL were performed in five hundred and twenty patients of liver cirrhosis with esoph-ageal variceal bleeding ( EVB). The patients were divided into three groups; liver cirrhosis group 332; liver cirrhosis with HCC group 70; portal azygos disconnection group 118. The results of EVL in different groups were compared and the relevant factors affected on the final outcomes were observed. Results Total eradication rate of EV was 42. 2% , 27. 1% and 89. 8% in three groups respectively. The rate of long-term recurrence of EV was 24. 1% , 42. 9% and 8. 5% , short-term recurrence of EVB was 3. 0% , 21. 4% , 4. 2% ; long-term rebleeding rate was 12. 0% , 20. 0% and 3. 4% respectively. Patients with HCC had a significant higher short-term rebleeding rate compared to those with liver cirrhosis only (P < 0. 05 ). Compared with non-operation group, the eradication rate was higher and rebleeding rate was lower in portal azygos disconnection group (P < 0. 05). The recurrent and recrudesce rate of EVB was higher if the hepatic function was worse before ligation (P < 0. 01 ). The patients had a lower recurrent and recrudesce rate of EVB and higher survival rate after ligation if propranolol was used ( P < 0. 01). In EV recrudesce patients, the widened left gastric vein and fastened mainly efferent blood flow were seen. Conclusion EVL, an effective and safe measure should be the first choice in treating EVB, but the result is closely associated with some factors.