肝硬化静脉曲张套扎及硬化术后近期不良预后危险因素

Risk factors in poor prognosis after endoscopic variceal ligation and endoscopic injection sclerotherapy of esophageal varices caused by liver cirrhosis

目的探讨肝硬化静脉曲张套扎及硬化术后不良预后的危险因素。方法收集天津医科大学总医院内镜中心行内镜下食管胃底静脉曲张套扎术（endoscopic variceal ligation,EVL）和硬化术（endoscopic injection sclerotherapy,EIS）治疗患者142例,对其性别、年龄、肝硬化病因、是否合并糖尿病、动脉粥样硬化及脾切除术史以及术前实验室检查、影像学检查、内镜下治疗方式等因素进行统计分析。结果肝硬化食管胃底静脉曲张EVL、EIS治疗不良预后的发生率为22.5%（32/142）,病死率2.1%（3/142）,存在不良预后因素者病死率高达9.4%（3/32）。其中术后早期出血率11.3%（16/142）,术后感染率9.2%（13/142）。Child-Pugh分级、治疗方式、门静脉血栓、腹水程度、术前胆红素水平与治疗后预后不良相关（均P〈0.05）,Child分级及门静脉血栓是内镜下治疗后预后不良的独立危险因素,OR值分别为4.006,14.06,95%CI分别为1.742-9.215,3.527-56.113。结论 Child-Pugh分级、治疗方式、门静脉血栓、腹水程度、术前胆红素水平是食管胃底静脉曲张内镜下治疗预后的相关因素,门静脉血栓、Child-Pugh分级是食管胃底静脉曲张内镜下治疗预后不良的独立危险因素,行EVL和EIS治疗前应严格掌握适应证,术后密切监测并积极预防。

Objective To evaluate the risk factors in poor prognosis after endoscopic variceal ligation（EVL） and endoscopic injection selerotherapy（EIS） of esophageal varices caused by liver cirrhosis. Methods A total of 142 cirrhotic patients with esophageal varices who received EVL or EIS at Endoscopy Center of Tianjin Medical University General Hospital were collected in this study. In order to discover risk factors, some items were analyzed, including gender, age, types of cirrhosis, existence of diabetes, atherosclerosis or splenectomy, serum examination and radiology examination and endoscopy treatment selection. Results The rate of poor prognosis after endoscopic treatment of esophageal varices was 22.5% （32/142） ,the mortality 2.1% （3/142）, 9.4% （3/32） in the patients with high risk factors, the rate of early rebleeding and infection after operation was 11.3 % （16/142） and 9.2 % （ 13/142）, respectively. Single factor analysis showed significant differences in liver function Child-Pugh classification, treatment method, portal vein thrombosis（PUT）, ascites degree and plasma bilirubin between good prognosis group and poor prognosis group （all P （0.05）. Multi-factors logistic regression analysis showed that liver function Child-Pugh classification and PVT were the independent factors of poor prognosis after endoscopic treatment（both P 〈0.01）, OR values were 4. 006, 14.06, 95% CI 1. 742-9. 215, 3. 527-56. 113. Conclusion Child-Pugh classification, treatment method, PVT, ascites degree and plasma bilirubin were associated with prognosis, PVT and Chiid-Pugh classification were independant risk factors of poor prognosis after endoscopic treatment. Good enrolling standard and close monitor after treatment were needed for preventing poor prognosis after EVL and EIS.