内镜下精准食管胃静脉曲张断流术患者预后及生存状况分析
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摘要
目的评价接受内镜下精准食管胃静脉曲张断流术(ESVD)患者的预后及生存状态。方法纳入2010年10月至2017年12月于首都医科大学附属北京地坛医院827例肝硬化伴食管胃静脉曲张破裂出血,并行ESVD治疗的患者。对患者的常规临床、实验室及影像学指标进行分析,随访患者的再出血和生存情况。将死亡患者以生存期1年为界,分为1年内死亡组和1年后死亡组,比较两组之间指标的差异。结果 827例患者中,早期再出血16例,占1. 93%;迟发性再出血248例,占29. 99%。患者1年、2年、3年、4年及5年的累计生存率为91. 8%、88. 6%、85. 3%、81. 9%和75. 5%。年龄、脾脏厚度、ALT、AST、总胆红素、肌酐、国际化标准比值及Child评分在1年内死亡组和1年后死亡组间存在显著差异(P <0. 05)。结论 ESVD在肝硬化伴食管胃静脉曲张破裂出血患者治疗中,获得了良好的近期及远期疗效。生存期较长患者的肝脏功能优于短期死亡组。
Objective To evaluate the prognosis and survival of patients undergoing endoscopic selective varices devascularization. Methods From Oct. 2010 to Dec. 2017,at the Ditan Hospital of Capital Medical University,827 liver cirrhosis patients complicated with gastroesophageal variceal bleeding were underwent ESVD therapy. The routine clinical,laboratory and imaging variables of the patients were retrospectively analyzed,and the survival status and rehemorrhage was recorded by followed up.Patients who died during the follow-up time were further divided into die within 1 year group and die beyond 1 year group,the variables were compared between the 2 groups. T test,chi-square test and rank sum test were performed for groups comparison. Kaplan-meier method was used for descriptive survival analysis. Results Among the 827 patients,16 had early rebleeding( 1. 93%),248 had delayed rebleeding( 29. 99%). The cumulative survival rate of 1,2,3,4 and 5 years was 91. 8%,88. 6%,85. 3%,81. 9% and79. 5%. Age,spleen thickness,ALT,AST,total bilirubin,creatinine,international standard ratios and Child score were significantly different between the short-term and long-term death groups( P < 0. 05). Conclusion The short-term and long-term efficacy of ESVD in liver cirrhosis patients accompanied with esophageal and gastric variceal bleeding seems to be better than the traditional treatment group,showing good therapeutic effect.
Objective To evaluate the prognosis and survival of patients undergoing endoscopic selective varices devascularization. Methods From Oct. 2010 to Dec. 2017,at the Ditan Hospital of Capital Medical University,827 liver cirrhosis patients complicated with gastroesophageal variceal bleeding were underwent ESVD therapy. The routine clinical,laboratory and imaging variables of the patients were retrospectively analyzed,and the survival status and rehemorrhage was recorded by followed up.Patients who died during the follow-up time were further divided into die within 1 year group and die beyond 1 year group,the variables were compared between the 2 groups. T test,chi-square test and rank sum test were performed for groups comparison. Kaplan-meier method was used for descriptive survival analysis. Results Among the 827 patients,16 had early rebleeding( 1. 93%),248 had delayed rebleeding( 29. 99%). The cumulative survival rate of 1,2,3,4 and 5 years was 91. 8%,88. 6%,85. 3%,81. 9% and79. 5%. Age,spleen thickness,ALT,AST,total bilirubin,creatinine,international standard ratios and Child score were significantly different between the short-term and long-term death groups( P < 0. 05). Conclusion The short-term and long-term efficacy of ESVD in liver cirrhosis patients accompanied with esophageal and gastric variceal bleeding seems to be better than the traditional treatment group,showing good therapeutic effect.
引文
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[8]中华医学会肝病学分会,中华学会消化病分会,中华医学会内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].临床肝胆病杂志,2016,32(2):203-219.
[9] Al-Bawardy B,Gorospe EC,Saleem A,et al. Outcomes and predictors of rebleeding after 2-octyl cyanoacrylate injection in acute gastric variceal hemorrhage[J]. J Clin Gastroenterol,2016,50(6):458-463.
[10] Ye Huai J,Chen Y. Cyanoacrylate injection compared with band ligation for acute gastric variceal hemorrhage:a meta-analysis of randomized controlled trials and observational studies[J].Gastroenterol Res Pract,2014,2014:806586.
[11] Chang YJ,Park JJ, Joo MK, et al. Long-term outcomes of prophylactic endoscopic histoacryl injection for gastric varices with a high risk of bleeding[J]. Dig Dis Sci,2010,55(8):2391-2397.
[12]李坪,魏红山,蒋煜,等.精准贲门胃静脉曲张断流术:一次性治疗食管胃连通型静脉曲张的近期疗效[J].内科急危重症杂志,2017,23(4):284-288.
[13] Chandra S, Holm A, Ei Abiad RG, et al. Endoscopic cyanoacrylate glue injection in management of gastric variceal bleeding:US tertiary care center experience[J]. J Clin Exp Hepatol,2018,8(2):181-187.
[14] Koziel S, Kobryn K, Paluszkiewicz R, et al. Endoscopic treatment of gastric varices bleeding with the use of n-butyl-2cyanoacrylate[J]. Prz Gastroenterol. 2015; 10(4):239-243.
[15] Akahoshi T,Hashizume M,Shimabukuro R,et al. Long-term results of endoscopic histoacryl injection sclerotherapy for gastric variceal bleeding:a 10-year experience[J]. Surgery,2002,131(Suppl 1):S176-181.
[16] Kang EJ,Jeong SW, Jang JY, et al. Long-term result of endoscopic histoacryl(N-butyl-2-cyanoacrlate)injection for treatment of gastric varices[J]. World J Gastroenterol. 2011; 17(11):1494-1500.
[17] North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophaegeal varices. A prospective multicenter study[J]. N Engl J Med,1988,319(15):983-989.
[18] Garcia-Tsao G, Abraldes JG, Berziqotti A, et al. Portal hypertensive bleeding in cirrhosis:risk stratification,diagnosis,and management:2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology,2017,65(1):310-335.
[19] D’Amico G,Pasta L,Morabito A,et al. Competing risks and prognostic stages of cirrhosis:a 25-year inception cohort study of494 patients[J]. Aliment Pharmacol Ther,2014,39(10):1180-1193.
[2] Haq I,Tripathi D. Recent advances in the management of variceal bleeding[J]. Gastroenterol Rep(Oxf),2017,5(2):113-126.
[3] Sarin SK,Lahoti D,Saxena SP,et al. Prevalence,classification and natural history of gastric varices:a long-term follow-up study in 568 portal hypertension patients[J]. Hepatolog,1992,16(6):1343-1349.
[4] de Franchis R, Primignani M. Natural history of portal hypertension in patients with cirrhosis[J]. Clin Liver Dis,2001,5(3):645-663.
[5] Tripathi D,Ferguson JW,Therapondos G,et al. Review article:recent advances in the management of bleeding gastric varices[J].Aliment Pharmacol Ther,2006,24(1):1-17.
[6] Ríos Castellanos E,Seron P, Gisbert JP, et al. Endoscopicinjection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in people with portal hypertension[J]. Cochrane Database Syst Rev,2015,(5):CD010180.
[7] De Franchis R,Baveno VI Faculty. Expanding consensus in portal hypertension:report of the Baveno VI consensus workshop:satratifying risk and individualizing care for portal hypertension[J]. J Hepatol,2015,63(3):743-752.
[8]中华医学会肝病学分会,中华学会消化病分会,中华医学会内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].临床肝胆病杂志,2016,32(2):203-219.
[9] Al-Bawardy B,Gorospe EC,Saleem A,et al. Outcomes and predictors of rebleeding after 2-octyl cyanoacrylate injection in acute gastric variceal hemorrhage[J]. J Clin Gastroenterol,2016,50(6):458-463.
[10] Ye Huai J,Chen Y. Cyanoacrylate injection compared with band ligation for acute gastric variceal hemorrhage:a meta-analysis of randomized controlled trials and observational studies[J].Gastroenterol Res Pract,2014,2014:806586.
[11] Chang YJ,Park JJ, Joo MK, et al. Long-term outcomes of prophylactic endoscopic histoacryl injection for gastric varices with a high risk of bleeding[J]. Dig Dis Sci,2010,55(8):2391-2397.
[12]李坪,魏红山,蒋煜,等.精准贲门胃静脉曲张断流术:一次性治疗食管胃连通型静脉曲张的近期疗效[J].内科急危重症杂志,2017,23(4):284-288.
[13] Chandra S, Holm A, Ei Abiad RG, et al. Endoscopic cyanoacrylate glue injection in management of gastric variceal bleeding:US tertiary care center experience[J]. J Clin Exp Hepatol,2018,8(2):181-187.
[14] Koziel S, Kobryn K, Paluszkiewicz R, et al. Endoscopic treatment of gastric varices bleeding with the use of n-butyl-2cyanoacrylate[J]. Prz Gastroenterol. 2015; 10(4):239-243.
[15] Akahoshi T,Hashizume M,Shimabukuro R,et al. Long-term results of endoscopic histoacryl injection sclerotherapy for gastric variceal bleeding:a 10-year experience[J]. Surgery,2002,131(Suppl 1):S176-181.
[16] Kang EJ,Jeong SW, Jang JY, et al. Long-term result of endoscopic histoacryl(N-butyl-2-cyanoacrlate)injection for treatment of gastric varices[J]. World J Gastroenterol. 2011; 17(11):1494-1500.
[17] North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophaegeal varices. A prospective multicenter study[J]. N Engl J Med,1988,319(15):983-989.
[18] Garcia-Tsao G, Abraldes JG, Berziqotti A, et al. Portal hypertensive bleeding in cirrhosis:risk stratification,diagnosis,and management:2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology,2017,65(1):310-335.
[19] D’Amico G,Pasta L,Morabito A,et al. Competing risks and prognostic stages of cirrhosis:a 25-year inception cohort study of494 patients[J]. Aliment Pharmacol Ther,2014,39(10):1180-1193.
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