肝硬化食管静脉曲张出血及硬化治疗效果的相关因素分析

Analysis of correlated factors between esophagogastric variceal bleeding and sclerotherapy in liver cirrhosis

目的研究肝硬化食管静脉曲张出血、硬化治疗效果与各种因素的相关性。方法对670例肝硬化食管静脉曲张出血并接受硬化治疗的患者选择26个相关因素,采用Spearman等级相关方法对肝硬化食管静脉曲张出血的相关因素及硬化治疗的相关参数进行分析。结果出血病程、出血次数与食管胃静脉曲张程度、门静脉扩张程度及肝功能分级不相关,与腹水和脾功亢进呈负相关。出血程度与食管胃静脉曲张程度、门静脉扩张程度、肝功能分级、腹水和脾功能亢进均不相关。食管静脉曲张与胃静脉曲张呈正相关,但两者均与门静脉扩张程度无关。硬化治疗后曲张静脉转归与食管静脉曲张程度分级呈正相关,与首次硬化术时机、硬化术首期次数、硬化术追加次数、硬化术总次数、硬化剂首次用量、硬化剂总用量呈负相关,与硬化剂类型无关。结论食管静脉曲张出血是多因素综合作用的结果,门静脉系统扩张不是唯一条件。硬化治疗后食管曲张静脉转归与硬化剂类型无关,硬化治疗首期次数和总次数、首次用量和总用量是主要影响因素。

Objective To investigate the correlated factors concerning esophago-gastric variceal bleeding and sclerotherapy in liver cirrhosis. Methods Twenty-six factors were selected for 670 patients with liver cirrhosis and esophagogastric variceal bleeding and received sclerotherapy in our hospital. Spearman relationship analyses were performed on factors concerning esophagogastric variceal bleeding and sclerotherapy. Results Duration and number of episodes of bleeding were not related to grade of esophagogastric varices, diameter of portal vein and hepatic function but negatively related to ascites and hypersplenism.Severity of bleeding was not related to all of the above parameters. Esophageal varices related to gastric varices while neither of them related to diameter of portal vein. Result of sclerotherapy related to grade of esophageal varices, and negatively related to number of operations in first-period sclerotherpy, supplementary sclerotherpy and total number of operations as well as to amount of scleroant of first-period sclerotherpy and total amount of scleroant. Types of sclerosant had no relationship with result of sclerotherapy. Conclusion Esophagogastric variceal bleeding is affected by multiple factors. Diameter of portal vein is not the only factor. Result of sclerotherapy is affected by number of operations and amount of scleroant and has nothing to do with types of sclerosant.