微探头超声内镜对肝硬化患者行食管静脉曲张套扎术治疗的预后价值评估

Clinical evaluation of prognostic value of microprobe endoscopic ultrasonography in esophageal variceal ligation for patients with cirrhosis

目的应用微探头超声内镜(EUS)对肝硬化患者食管静脉曲张套扎术(EVL)治疗的预后评估。方法选择2015年8月-2017年8月于天津市第二人民医院住院治疗的肝硬化患者64例,均进行EVL根治术治疗。EVL根治术后,患者每半年复查胃镜及EUS,随访1年,胃镜观察有无食管静脉复发。EUS观察食管黏膜下静脉曲张及侧枝静脉的最大直径,记录其曲张程度。结果①EVL根治术后1年内,死亡2例,其余62例均完成随访。其中,复发30例,复发率48.4%(30/62);再次出现食管静脉曲张破裂出血患者4例,出血率6.5%(4/62);②与治疗前相比,EVL根治术后食管黏膜下静脉曲张中/重度例数、食管旁静脉曲张及周围静脉曲张重度例数,差异无统计学意义(P>0.05);③EVL根治术后,与食管静脉曲张未复发组相比,复发组食管黏膜下静脉曲张中/重度例数明显增多,食管旁静脉曲张及周围静脉曲张重度例数明显增多,差异有统计学意义(P=0.000)。结论应用微探头EUS随访EVL根治术患者,观察食管黏膜下静脉曲张及食管侧枝静脉的程度,对EVL术后食管静脉曲张复发有一定的预测价值。

Objective To evaluate prognostic value using microprobe endoscopic ultrasonography in esophageal variceal ligation (EVL) for patients with cirrhosis. Methods 64 inpatients with liver cirrhosis were selected from August 2015 to August 2017 as research subjects. All the patients received EVL treatment. After EVL treatment, the patients were examined by gastroscopy and endoscopic ultrasonography every half a year, followed up for 1 year. The recurrence of the esophagus was observed by gastroscopy. The maximum diameter of esophageal submucosal varices and collateral veins was observed by endoscopic ultrasonography, and the degree of varicosity was recorded. Results Within 1 year after EVL treatment, 2 patients died. At the end of the follow-up, in the 62 patients, 30 patients had recurrence, and the recurrence rate was 48.4%(30/62). Four cases of esophageal varicose hemorrhage occurred again, and the bleeding rate was 6.5%(4/62);Compared with before treatment, there were no significant differences in the number of moderate/severe cases of esophageal submucosal varices, and severe cases of esophageal collateral veins after EVL treatment (P > 0.05);After EVL treatment, compared with the non recurrence group of esophageal varices, the number of moderate/severe cases of esophagus submucosal varices was significantly increased, the number of severe cases of paroesophageal varices and periesophageal varices increased significantly in the recurrent group. There were significant difference (P = 0.000). Conclusion The extent of esophageal submucosal varices and collateral veins in patients with EVL treatment were followed up with microprobe ultrasound endoscopy, which had a certain predictive value for the recurrence of esophageal varices after EVL.