不同肝功能终末期肝病模型分级患者食管曲张静脉套扎术疗效及预后

The effectiveness of endoscopic variceal ligation in patients with different grades of liver function

目的探讨术前肝功能分级对内镜下食管曲张静脉套扎术(EVL)疗效和预后的影响以及对手术病例选择的指导意义。方法对156例肝硬化食管曲张静脉套扎术的患者术前的肝功能进行终末期肝病模型(MELD)评分,将这些患者按MELD分值分为(≤7分)58例、(7～9分)54例、(≥9分)44例3个组,对这些患者随访套扎术后的远期生存率及生存状况。结果MELD≤7分的的患者中,50%生存率超过45个月,7～9分的的患者中,50%生存率在47．34个月,而≥9分的患者50%生存率在24．89个月。前两组的半数生存率显著大于第3组,生存率差异有统计学意义。结论EVL已成为临床治疗由食管静脉曲张引起的上消化道大出血的有效方法,术后生存率与术前肝功能有直接相关性,术前肝功能对套扎术病例的选择有指导意义。

Objective To evaluate the effectiveness of endoscopic variceal ligation （EVL） in patients with different grades of liver function. Methods MELD scores were determined for 156 patients before their EVL operations. After the EVL these patients were followed-up and their survival rates were analyzed. Results Fifty percent of the patients whose MELDs were less than or equal to 7 survived longer than 45 months after the EVL; in those with MELDs between 7 and 9.50% of the patients survived 47.34 months; however, the figure for those whose MELD were more than 9 survived only 24.89 months. In the first two groups, 50% of the patient＇s survival duration was significantly longer than that of the third group. The difference was statistically significant. Conclusion EVL becomes an effective clinical way to treat hemorrhage of esophagus varicose veins. The survival rate for this procedure is directly correlated with the liver function of the patient before the EVL.