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
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摘要
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.
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.
引文
[1]LI Z Q,LINGHU E Q,HU M,et al.Endoscopic measurement of variceal diameter[J].World J Gastroenterol,2015,21(7):2140-2146.
[2]HEINZOW H S,KABAR I.New treatment option of acute massive and refractory esophageal variceal bleeding[J].Z Gastroenterol,2016,54(7):663-664.
[3]LO G H,LIN C W,HSU Y C.A controlled trial of early versus delayed feeding following ligation in the control of acute esophageal variceal bleeding[J].J Chin Med Assoc,2015,78(11):642-647.
[4]中华医学会消化内镜学分会食管胃静脉曲张学组.消化道静脉曲张及出血的内镜诊断和治疗规范试行方案(2009年)[J].中华消化内镜杂志,2010,27(1):1-4.[4]Group of Esophageal Varicosity,Chinese Society of Digestive Endoscopy.Tentative guidelines for endoscopic diagnosis and treatment of varicosity and variceal bleeding in digestive tract(2009)[J].Chin J Dig Endosc,2010,27(1):1-4.Chinese
[5]LEE Y T,CHAN F K,CHING J Y,et a1.Diagnosis of gastroesophageal varices and portal collateral venous abnormalities by endosonography in cirrhotic patients[J].Endoscopy,2002,34(5):391-398.
[6]MANDORFER M,PECK-RADOSAVLJEVIC M,REIBERGER T.Prevention of progression from small to large varices:are we there yet?An updated meta-analysis[J].Gut,2017,66(7):1347-1349.
[7]KIM G,CHO Y Z,BAIK S K.Assessment for risk of bias in systematic reviews and Meta-analyses in the field of hepatology[J].Gut Liver,2015,9(6):701-706.
[8]LRISAWA A,OBARA K,SATO Y,et a1.EUS analysis of collateral veins inside and outside the esophageal wall in portal hypertension[J].Gastrointest Endosc,1999,50(3):374-380.
[9]尚瑞莲,孙自勤,贾爱芹,等.超声内镜引导下硬化剂注射对食管静脉曲张套扎术后残留曲张静脉及穿通支序贯治疗的观察[J].解放军医学杂志,2014,39(7):572-575.[9]SHANG R L,SUN Z Q,JIA A Q,et al.Efficacy of EUS-guided sclerotherapy on residual esophageal varices and perforating vein after esophageal varices ligation[J].Med J Chin PLA,2014,39(7):572-575.Chinese
[10]王春妍,蒋贝,李嘉,等.超声内镜对肝硬化患者胃食管静脉曲张早期诊断价值的评估[J].中华肝脏病杂志,2016,24(9):671-675.[10]WANG C Y,JIANG B,LI J,et al.Value of endoscopic ultrasound in early diagnosis of gastroesophageal varices in patients with liver cirrhosis[J].Chin J Hepatol,2016,24(9):671-675.Chinese
[2]HEINZOW H S,KABAR I.New treatment option of acute massive and refractory esophageal variceal bleeding[J].Z Gastroenterol,2016,54(7):663-664.
[3]LO G H,LIN C W,HSU Y C.A controlled trial of early versus delayed feeding following ligation in the control of acute esophageal variceal bleeding[J].J Chin Med Assoc,2015,78(11):642-647.
[4]中华医学会消化内镜学分会食管胃静脉曲张学组.消化道静脉曲张及出血的内镜诊断和治疗规范试行方案(2009年)[J].中华消化内镜杂志,2010,27(1):1-4.[4]Group of Esophageal Varicosity,Chinese Society of Digestive Endoscopy.Tentative guidelines for endoscopic diagnosis and treatment of varicosity and variceal bleeding in digestive tract(2009)[J].Chin J Dig Endosc,2010,27(1):1-4.Chinese
[5]LEE Y T,CHAN F K,CHING J Y,et a1.Diagnosis of gastroesophageal varices and portal collateral venous abnormalities by endosonography in cirrhotic patients[J].Endoscopy,2002,34(5):391-398.
[6]MANDORFER M,PECK-RADOSAVLJEVIC M,REIBERGER T.Prevention of progression from small to large varices:are we there yet?An updated meta-analysis[J].Gut,2017,66(7):1347-1349.
[7]KIM G,CHO Y Z,BAIK S K.Assessment for risk of bias in systematic reviews and Meta-analyses in the field of hepatology[J].Gut Liver,2015,9(6):701-706.
[8]LRISAWA A,OBARA K,SATO Y,et a1.EUS analysis of collateral veins inside and outside the esophageal wall in portal hypertension[J].Gastrointest Endosc,1999,50(3):374-380.
[9]尚瑞莲,孙自勤,贾爱芹,等.超声内镜引导下硬化剂注射对食管静脉曲张套扎术后残留曲张静脉及穿通支序贯治疗的观察[J].解放军医学杂志,2014,39(7):572-575.[9]SHANG R L,SUN Z Q,JIA A Q,et al.Efficacy of EUS-guided sclerotherapy on residual esophageal varices and perforating vein after esophageal varices ligation[J].Med J Chin PLA,2014,39(7):572-575.Chinese
[10]王春妍,蒋贝,李嘉,等.超声内镜对肝硬化患者胃食管静脉曲张早期诊断价值的评估[J].中华肝脏病杂志,2016,24(9):671-675.[10]WANG C Y,JIANG B,LI J,et al.Value of endoscopic ultrasound in early diagnosis of gastroesophageal varices in patients with liver cirrhosis[J].Chin J Hepatol,2016,24(9):671-675.Chinese