内镜治疗肝癌合并门静脉癌栓引起的食管胃底静脉曲张出血的疗效分析

Efficacy of endoscopic therapy in treatment of esophageal gastric varices bleeding in patients with hepatocellular carcinoma and portal vein tumor thrombus

目的明确内镜治疗肝癌合并门静脉癌栓患者发生食管胃底静脉曲张出血的止血效果与意义。方法回顾性分析2013年1月-2015年12月首都医科大学附属北京地坛医院住院收治食管胃底静脉曲张出血的肝癌伴门静脉癌栓的患者,比较非内镜治疗组和内镜治疗组患者止血治疗效果、主要死亡原因及生存时间。结果共纳入76例患者,非内镜治疗组27例,内镜治疗组49例。非内镜治疗组有40.7%(11/27)的患者1周内死亡,81.5%(22/27)死于食管胃底静脉曲张出血,平均生存期为(42.03±13.94)d;内镜治疗组仅16.3%(8/49)的患者1周内死亡(P<0.05),55.1%(27/49)死于食管胃底静脉曲张出血(P<0.05),平均生存期为(174.24±34.42)d(P<0.05)。结论内镜下治疗能有效地降低患者死于食管胃底静脉曲张出血的风险,延长患者生存期,具有临床意义。

Objective To compare the effect and survival period of endoscopic treatment group and non endoscopic treatment group of esophageal gastric varices bleeding in patients with hepatocellular carcinoma and portal vein tumor thrombus,in order to define the significance of endoscopic therapy for prolonging the survival period of patients.Methods76patients diagnosed as esophageal gastric varices bleeding with hepatocellular carcinoma and portal vein tumor thrombus from Jan.2013to Dec.2015were enrolled,of all these cases,27were non endoscopic treatment group and49were endoscopic treatment group.The medical records were analyzed retrospectively.Then compare the effect of emergency treatment,the main causes of death and survival time of the two groups.Results In the non endoscopic treatment group,40.7%(11/27)patients died in one week after bleeding,81.5%(22/27)patients died of esophageal gastric varices bleeding,the mean survival period was(42.03±13.94)days;In the endoscopic treatment group,only16.3%(8/49)patients died in one week(P<0.05),55.1%(27/49)patients died of esophageal gastric varices bleeding(P<0.05),the mean survival time was(174.24±34.42)days(P<0.05).Conclusions Endoscopic therapy can effectively reduce the risk of death from acute hemorrhage and prolong the survival time in patients with hepatocellular carcinoma and portal vein tumor thrombus.