内镜下食管静脉曲张结扎术后早期再出血的危险因素分析

Analysis of the risk factors in early rebleeding after endoscopic variceal ligation

目的明确内镜下食管静脉曲张结扎术（EVL）后早期再出血率并分析其危险因素。方法总结1992年至2002年问593例肝硬化和（或）肝癌患者单纯EVL治疗的资料，统计接受EVL治疗者的性别、年龄、合并疾患、肝硬化原因、是否患肝癌、分流、断流及脾切除术史、入院前后临床表现、实验室检查结果、影像学结果、胃镜结果、药物治疗情况等因素对术后早期再出血发生率和患者预后的影响，寻找独立危险因素。结果曲张静脉根数、空腹血糖、凝血酶原时间、血甲胎蛋白正常与否为EVL术后早期再出血的独立危险因素，P值分别为0．015，0．026，0．014，0．026。随曲张静脉根数的增加（≥4根），空腹血糖（〉7．0mmol／L）和血甲胎蛋白升高，凝血酶原活动度降低（〈50％），EVL术后早期再出血的可能性增加，OR值分别为3．120，4．800，0．283，4．328，95％CI分别为1．324～7．335，1，662～8．775，0．103～0．708，1．349～13．883。结论曲张静脉根数、空腹血糖、凝血酶原时间、血甲胎蛋白正常与否影响EVL术后早期出血，EVL术前应予积极的治疗及预防。

Objective To summarize the early rebleeding rate after Endoscopic variceal ligation （EVL） as well as to analyze the risk factors. Methods The records of patients treated with EVL due to cirrhosis and/or hepatocellular carcinoma in the endoscopy center were surveyed. Totally 593 procedures of EVL had been performed in the period between 1992 and 2002. In order to discover independent risk factors, a lot of items were analyzed, including gender, age, coexistent diseases, types of cirrhosis, existence of hepatocellular carcinoma, the history of ligation or shunt operation and/or splenectomy, clinical presentation before and after admission, serum examination and radiology results, endoscopy discription, histologic findings and phamarcotherapy. Results Varices number, serum glucose and α-fetoprotein levels and prothrombin time were independent risk factors of early rebleeding after EVL, P values were 0. 015, 0. 026, 0. 026 and 0. 014 respectively. With increase of the number of varices （4 or more）, serum glucose （ higher than 7.0 mmol/L） and α-fetoprotein levels （ higher than the cut-off value） as well as decrease of prothrombin time activity （ lower than 50% ）, the possibility of early rebleeding after EVL increased, with the OR values of 3. 120, 4. 800, 0. 283, 4. 328, and the 95% CI of 1. 324-7. 335, 1. 662-8. 775, 0. 103-0. 708, 1. 349-13. 883 respectively. Conclusion The early rebleeding rate after EVL is effected by the abnormalities in varices number, serum glucose and α-fetoprotein levels and prothrombin time, effective measures for prevention and treatment should be adopted before EVL.