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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2016, Vol. 05 ›› Issue (03) : 153 -157. doi: 10.3877/cma.j.issn.2095-3232.2016.03.007

所属专题： 文献；

临床研究

门静脉血栓形成对内镜下食管静脉曲张套扎术临床疗效的影响
陈伶君1, 郭云蔚1, 林颖1, 郑丰平1,†()   
  1. 1. 510630　广州，中山大学附属第三医院消化内科
  • 收稿日期:2016-03-08 出版日期:2016-06-10
  • 通信作者: 郑丰平
  • 基金资助:
    广东省科技计划项目(2008B030301038)

Influence of portal vein thrombosis on clinical efficacy of endoscopic esophageal variceal ligation

Lingjun Chen1, Yunwei Guo1, Ying Lin1, Fengping Zheng1,†()   

  1. 1. Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2016-03-08 Published:2016-06-10
  • Corresponding author: Fengping Zheng
  • About author:
    Corresponding author: Zheng Fengping, Email:
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陈伶君, 郭云蔚, 林颖, 郑丰平. 门静脉血栓形成对内镜下食管静脉曲张套扎术临床疗效的影响[J]. 中华肝脏外科手术学电子杂志, 2016, 05(03): 153-157.

Lingjun Chen, Yunwei Guo, Ying Lin, Fengping Zheng. Influence of portal vein thrombosis on clinical efficacy of endoscopic esophageal variceal ligation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2016, 05(03): 153-157.

目的

探讨门静脉血栓形成（PVT）对内镜下食管静脉曲张套扎术（EVL）治疗肝硬化食管静脉曲张破裂出血（EVH）疗效的影响。

方法

回顾性分析2005年1月至2014年12月在中山大学附属第三医院接受内镜下EVL治疗且随访超过6个月的314例肝硬化EVH患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。根据治疗时有否PVT将患者分为PVT组和对照组。其中PVT组72例，男61例，女11例；平均年龄（50±11）岁。对照组242例，男206例，女36例；年龄（47±11）岁。比较两组患者的临床疗效，分析PVT与食管静脉曲张（EV）消除率、EV再出血率的关系。两组EVL疗程数比较采用t检验，率的比较采用χ2检验。PVT与EV消除率、EV再出血率的关系采用单因素logistic回归分析。

结果

PVT组发生急性EVH 36例，对照组115例，经EVL治疗后两组急诊止血率均为100%。PVT组EV消除率为76%（55/72），明显低于对照组的90%（218/242） （χ2=9.166，P<0.05）。PVT组EVL疗程数为（3.4±1.6）个，明显多于对照组的（2.8±1.1）个（t=3.065，P<0.05）。PVT组EV再出血率为36%（26/72），明显高于对照组的21%（51/242） （χ2=6.779，P<0.05）。PVT是影响患者EV消除率的危险因素（OR=0.356，95%CI：0.179～0.709，P<0.05），亦是影响患者EV再出血的危险因素（OR=2.383，95%CI：1.354～4.196，P<0.05）。

结论

PVT是影响内镜下EVL治疗肝硬化EVH患者EV消除率及再出血率的危险因素。

关键词: 门静脉, 肿瘤细胞，循环, 肝硬化, 食管和胃静脉曲张, 胃镜, 治疗应用
Objective

To explore the influence of portal vein thrombosis (PVT) on the clinical efficacy of endoscopic esophageal variceal ligation (EVL) in cirrhotic patients with esophagogastric variceal hemorrhage (EVH).

Methods

Clinical data of 314 cirrhotic patients with EVH who underwent endoscopic EVL and were followed up for more than 6 months in the Third Affiliated Hospital of Sun Yat-sen University between January 2005 and December 2014 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients were divided into the PVT group and the control group according to whether they had PVT during treatment. Among the 72 patients in the PVT group, 61 were males and 11 were females with the mean age of (50±11) years old. Among the 242 patients in the control group, 206 were males and 36 were females with the mean age of (47±11) years old. The clinical efficacy of two groups was compared, and the correlation between PVT and the elimination rate of esophageal varices (EV) as well as the recurrent bleeding rate of EV was analyzed. The number of EVL treatment period in two groups was compared using t test and the rate was compared using Chi-square test. Univariate logistic regression analysis was conducted for the correlation between PVT and the elimination rate, recurrent bleeding rate of EV.

Results

Thirty-six patients in the PVT group and 115 patients in the control group developed acute EVH. After EVL, the emergency hemostatic rate of both groups was 100%. The elimination rate of EV in the PVT group was 76%(55/72), significantly lower than 90%(218/242) in the control group (χ2=9.166, P<0.05). The number of EVL treatment period in the PVT group was 3.4±1.6, significantly more than 2.8±1.1 in the control group (t=3.065, P<0.05). The recurrent bleeding rate of EV in the PVT group was 36%(26/72), significantly higher than 21%(51/242) in the control group (χ2=6.779, P<0.05). PVT was a risk factor for both the elimination rate of EV (OR=0.356, 95%CI: 0.179-0.709, P<0.05) and the recurrent bleeding rate of EV (OR=2.383, 95%CI: 1.354-4.196, P<0.05).

Conclusion

PVT is a risk factor for both the elimination rate of EV and the recurrent bleeding rate of EV in cirrhotic patients with EVH treated by endoscopic EVL.

Key words: Portal vein, Neoplastic cells, circulating, Liver cirrhosis, Esophageal and gastric varices, Gastroscopes, Therapeutic uses
表1 不同部位PVT对内镜下EVL治疗肝硬化EVH患者临床疗效的比较
PVT部位 例数 EV消除率 EV复发率 EV再出血率 EV出血相关死亡率
门静脉主干 15 93%（14/15） 57%（8/14） 40%（6/15） 7%（1/15）
门静脉分支 18 78%（14/18） 43%（6/14） 44%（8/18） 6%（1/18）
门静脉主干+分支 21 62%（13/21） 31%（4/13） 33%（7/21） 5%（1/21）
门静脉+脾静脉 6 6/6 3/6 1/6 2/6
门静脉+肠系膜上静脉 5 3/5 0/3 2/5 0/5
门静脉+脾静脉+肠系膜上静脉 7 5/7 3/5 4/7 1/7
χ2值 ? 9.271 6.014 2.876 5.079
P值 ? 0.099 0.305 0.719 0.303
表2 不同程度PVT对内镜下EVL治疗肝硬化EVH患者临床疗效的比较
分组 例数 EV消除率 EV复发率 EV再出血率 EV出血相关死亡率
部分PVT组 64 80%（51/64） 45%(23/51) 38%(24/64) 6%(4/64)
完全PVT组 8 4/8 1/4 4/8 2/8
χ2值 ? 2.024 0.066 0.089 1.278
P值 ? 0.155 0.797 0.765 0.258
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