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

doi:10.3877/cma.j.issn.2095-3232.2016.03.007

Abstract

Abstract:

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

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.

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Figures/Tables 2

References 20

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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

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

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

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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