内镜下治疗门静脉高压性食管胃静脉曲张出血后再出血的危险因素分析

Analysis of risk factors for rebleeding after endoscopic treatment of portal hypertensive esophageal and gastric variceal bleeding

目的探讨内镜下治疗门静脉高压性食管胃静脉曲张出血后再出血的危险因素。方法收集2020年1月至2022年12月于南通大学附属海安市人民医院成功接受内镜下治疗的116例门静脉高压性食管胃静脉曲张出血患者的临床资料,按照术后6个月随访期间是否发生再出血将患者分为再出血组(n=37)和对照组(n=79)。收集所有患者首次内镜下治疗时的基线资料,比较两组患者的临床特征、内镜下检查情况、内镜下治疗情况以及术后治疗情况,分析内镜下治疗门静脉高压性食管胃静脉曲张出血后再出血相关的危险因素。结果再出血组患者的年龄、合并门静脉血栓的比例、合并糖尿病的比例、合并低蛋白血症的比例均高于对照组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,年龄≥60岁、合并门静脉血栓、合并糖尿病及合并低蛋白血症均为内镜下治疗门静脉高压性食管胃静脉曲张出血后再出血的独立危险因素(P﹤0.05)。结论老年(年龄≥60岁)、合并门静脉血栓、合并糖尿病、合并低蛋白血症均会增加内镜下治疗门静脉高压性食管胃静脉曲张出血后再出血的风险。

Objective To investigate the risk factors of rebleeding after endoscopic treatment of portal hypertensive esophageal and gastric variceal bleeding.Method The clinical data of 116 patients with portal hypertensive esophageal and gastric variceal bleeding who successfully received endoscopic treatment at Hai'an People's Hospital,Nantong University from January 2020 to December 2022 were collected.The patients were divided into rebleeding group(n=37)and control group(n=79)based on whether there was rebleeding during the 6-month follow-up period after surgery.The baseline data of all patients at the time of their first endoscopic treatment were collected,the clinical characteristics,endoscopic examination,endoscopic treatment,and postoperative treatment of two groups of patients were compared,and the risk factors related to rebleeding after endoscopic treatment of portal hypertension esophagogastric varices bleeding was analyzed.Result The age,the proportion of patients with portal vein thrombosis,the proportion of patients with diabetes and the proportion of patients with hypoproteinemia in the rebleeding group were significantly higher than those in the control group(P<0.05).Multivariate analysis showed that age≥60 years old,portal vein thrombosis,diabetes and hypoproteinemia were independent risk factors for rebleeding after endoscopic treatment of portal hypertensive esophageal and gastric varices bleeding(P<0.05).Conclusion The elderly(age≥60 years old),portal vein thrombosis,diabetes,and hypoproteinemia all increase the risk of rebleeding after endoscopic treatment of portal hypertensive esophageal and gastric varices bleeding.