影响肝硬化食管胃底静脉曲张内镜治疗效果的多因素分析

赵睿; 顾林; 柯希权; 马振增; 朱玉; 郑海伦

doi:10.13898/j.cnki.issn.1000-2200.2022.08.017

影响肝硬化食管胃底静脉曲张内镜治疗效果的多因素分析

Multivariate analysis of the influencing factors of endoscopic treatment effects in esophageal-gastro varices in cirrhosis

摘要

摘要:
目的分析影响食管胃底静脉曲张内镜治疗效果的相关因素，探讨影响术后再出血的危险因素及改善其预后的策略。
方法收集2017年1月至2020年9月186例肝硬化并食管胃底静脉曲张并接受内镜治疗病人的相关资料，根据内镜治疗后1年内是否发生出血或再出血分为未出血组124例和出血组62例，分析影响食管胃底静脉曲张术后出血的相关影响因素。
结果2组病人入院时肝功能Child-Pugh分级、曲张静脉直径、是否有红色征、手术方式、治疗次数、是否规律随访、血红蛋白水平、血小板计数、凝血酶原时间(PT)差异均有统计学意义(P < 0.05~P < 0.01)；多因素logistic回归分析结果显示，肝功能Child-Pugh分级、曲张静脉直径、是否有红色征、PT、是否规律随访及治疗次数均是影响内镜治疗术后出血的相关独立因素(P < 0.05~P < 0.01)。
结论肝功能Child-Pugh分级、曲张静脉直径、红色征、PT是内镜治疗术后发生再出血的独立危险因素，严格的规律随访和适当增加治疗次数可降低再出血风险，有利于改善病人的预后。

Abstract:
ObjectiveTo analyze the related factors affecting the effects of endoscopic treatment of esophageal-gastro varices, and explore the risk factors of postoperative rebleeding and strategies to improve its prognosis.
MethodsThe relevant data of 186 patients with liver cirrhosis complicated with esophagogastric varices treated with endoscopy from January 2017 to September 2020, were collected.According to the occurrence of bleeding or rebleeding within 1 year after endoscopic treatment, the patients were divided into the non-bleeding group(n=124) and bleeding group(n=62).The related factors affecting the postoperative bleeding of esophageal-gastro varices were analyzed.
ResultsThe differences of the Child-Pugh grade of liver function, varicose vein diameter, red sign, operation method, treatment times, regular follow-up, hemoglobin level, platelet count and prothrombin time(PT) between two groups were statistically significant on admission(P < 0.05 to P < 0.01).The results of multivariate logistic regression analysis showed that the Child-Pugh grade of liver function, maximum diameter of varicose veins, red sign, PT, regular follow-up and treatment times were the related independent factors affecting the bleeding after endoscopic treatment(P < 0.05 to P < 0.01).
ConclusionsThe Child-Pugh grade of liver function, varicose vein diameter, red sign and PT are the independent risk factors of rebleeding after endoscopic treatment.Strict regular follow-up and appropriate increase of treatment times can reduce the risk of rebleeding and improve the prognosis of patients.

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