内镜下食管静脉曲张套扎术对肝硬化食管静脉曲张患者预后及肝静脉压力梯度的影响分析

Endoscopic esophageal variceal ligation in cirrhosis of liver patients with esophageal varices and the effect of hepatic venous pressure gradient

目的分析内镜下食管静脉曲张套扎术(esophageal varices ligation,EVL)对肝硬化食管静脉曲张患者预后及肝静脉压力梯度(hepatic venous pressure gradient,HVPG)的影响。方法选择2014年6月至2017年6月本院收治的97例肝硬化食管静脉曲张患者为研究对象,入组患者均为中度或重度食管静脉曲张,HVPG>20 mm Hg且不接受经颈静脉肝内门体静脉分流术,均行EVL治疗,评价EVL的治疗效果,统计患者术后不良反应发生情况,分析EVL对HVPG的影响及HVPG变化与患者预后的关系。结果 97例患者中64例无静脉残留,根治率为65.98%,25例曲张血管明显缩短变小,血疱征或红色征消失,有效率为25.77%,3例无明显变化,5例术后2~4周内出现呕血,无效率为8.25%。9例患者近期出现出血,后经调查为患者术后过早下床活动、过早进食硬质食物导致,及时进行制酸、扩容、降低门静脉压力处理后出血得到控制。21例患者术后出现胸骨后疼痛、吞咽困难、术后发热及食管狭窄等并发症,并发症发生率为21.65%;患者并发症程度均较轻,除发热患者进行退热处理外,其余患者均未进行特殊处理,患者临床症状自行改善。术后2~4周,出血复发患者HVPG为16~21 mm Hg,89例(96.74%)未出血患者HVPG为7.88~14.21 mm Hg,此外3例(3.26%)未出血患者HVPG分别为16.05、16.14、16.38 mm Hg。Logistic回归分析显示高水平HVPG是患者术后早期出血复发的独立危险因素(P=0.01,OR=1.82)。结论 EVL有助于降低肝硬化食管静脉曲张患者的HVPG,且不良反应较轻,安全性高。高水平HVPG是肝硬化食管静脉曲张患者术后早期出血复发的独立危险因素,检测HVPG对评估患者预后具有重要价值。

Objective To study the effect of endoscopic esophageal variceal ligation（EVL） on the prognosis of cirrhosis of liver patients with esophageal varices and the hepatic venous pressure gradient（HVPG）. Method A total of 97 cirrhosis of liver patients with esophageal varices were enrolled in our hospital from June 2014 to June 2017. Patients with hepatic venous pressure gradient HVPG 20 mm Hg and those who did not receive transjugular intrahepatic portosystemic shunt, were moderate or severe esophageal varices, they were treated with EVL, evaluated the therapeutic effect of EVL, the effect of EVL on HVPG and the relationship between HVPG and prognosis were analyzed. Result 97 patients with esophageal varices after EVL treatment, 64 patients with postoperative examination showed no patients with intravenous, radical rate was 65.98%, 25 cases of varicose veins obviously shortened and became smaller, blood blisters sign or red sign disappeared, the effective rate was 25.77%, 3 patients had no significant changes in postoperative detection, 5 patients with hematemesis 2 ~ 4 weeks after operation, the inefficiency rate was 8.25%. hemorrhage occurred in 9 patients recently, after the investigation, those patients were out-of-bed and eating hard food prematurely after operation, control of hemorrhage duly after the treatment of acid production, dilatation and reduction of portal pressure. Patients with postoperative complications such as posterior sternal pain, dysphagia, postoperative fever and esophageal stricture and other complications in 21 cases, the incidence of complications was 21.65%; the degree of complications were mild, except the fever patients, the rest patients did not receive special treatment, the clinical symptoms relieved. HVPG were 7.8 ~ 14.21 mm Hg in 89 cases（96.74%） patients without hemorrhage, and HVPG in 3 cases（3.26%） patients without hemorrhage were 16.05, 16.14, 16.38 mm Hg respectively. Logistic regression analysis showed that high level HVPG was an independent risk factor for early postoperative hemorrhage recurrence（P = 0.01, OR = 1.82）. Conclusion EVL can reduce the HVPG of cirrhosis of liver patients with esophageal varices, with mild adverse reactions and high safety. High-level HVPG is an independent risk factor for early postoperative hemorrhage recurrence, detection of HVPG is of great value in evaluating the prognosis of patients.