肝硬化食管静脉曲张出血及硬化治疗效果的相关因素分析

目的 研究肝硬化食管静脉曲张出血，硬化治疗效果与各种因素的相关性。方法 对670例肝硬化食管静脉曲张出血并接受硬化治疗的患者选择26个相关因素，采用Spearman等级相关方法对肝硬化食管静脉曲张出血的相关因素及硬化治疗的相关参数进行分析。结果 出血病程，出血次数和食管胃静脉曲张程度，门静脉扩张程度及肝功能分级不相关，与腹水和脾功亢进呈负相关，出血程度与食管胃静脉曲张程度，门静脉扩张程度及肝功能分级不相关，与腹水和脾功亢进呈负相关，出血程度与食管胃静脉曲张程度，门静脉扩张程度，肝功能分级，腹水和脾功能亢进均不相关，食管静脉曲张与胃静脉曲张呈正相关，但两者均与门静脉扩张程度无关，硬化治疗后曲张静脉转归与食管静脉曲张程度分级呈正相关，与资产硬化术时机，硬化术首期次数，碍化术追加次数，硬化术总次数，硬化剂首次用量，硬化剂总用量呈负相关，与硬化剂类型无关，结论 食管静脉曲张出血是多因素综合作用的结果，门静脉系统扩张不是唯一条件，硬化治疗后食管曲张静脉转归与硬化剂类型无关，硬化治疗首期次数和总次数，首次用量和总用量是主要影响因素。     

肝硬化食管静脉曲张出血患者硬化治疗的生存分析

目的 研究肝硬化食管静脉曲张出血（CEVB）硬化治疗的各种因素对预后生存的影响,并进行定量分析,建立生存模型,估计生存率。方法 对我院1987年4月至2000年6月间670例CEVB硬化治疗患者的29项预后因子及生存期的随访资料采用Kaplan-Meier法进行生存率的估计,以Cox比例风险模型进行危险因素分析。结果 Cox模型分析结果为肝功能Child分级与曲张静脉转归是2个显著影响预后生存的因素。1、3、5年生存率分别是93.29%、85.24%、74.27%。肝功能Child分级为A、B、C级者,1年生存率分别是98.88%、95.97%、82.32%,5年生存率分别是91.42%、78.35%、49.48%,其生存曲线有明显差异。食管曲张静脉转归分为消失、基本消失、Ⅰ度、Ⅱ度、Ⅲ度,其1年生存率分别是96.08%、93.94%、85.84%、85.00%、53.85%,5年生存率分别是81.45%、67.76%、72.89%、61.59%、35.90%,生存曲线有明显差异,其Cox模型单因素和多因素分析P值分别为0.000和0.020。但5条曲线在50个月时有聚合趋势,可能说明硬化治疗静脉曲张改善保持时间约为4年。肝功能Child C级时静脉曲张转归为消失和基本消失者,其1年生存率均为88.24%,2年生存率为77.98%-83.63%,仍高于总体肝功能Child C级时的生存率。结论 CEVB的硬化治疗是一种有效的急诊止血和防止再出血的治疗方法,在肝功能Child C级时也能改善预后,所以应积极实施,并且4年左右重复硬化治疗可显著提高生存率。     

肝硬化食管胃静脉曲张破裂出血的预防和治疗新进展

肝硬化患者门静脉系统血流受阻导致门静脉及其属支血管内静力压力升高并伴侧支循环形成,临床主要表现为腹水、脾大、肝性脑病以及食管胃静脉曲张破裂出血等.其中,食管胃静脉曲张破裂出血的病死率最高,是最常见的消化系统急症之一.肝硬化患者上消化道出血的原因中,70％是因为静脉曲张破裂出血.     

230例食管胃静脉曲张出血患者急诊硬化治疗

总结２３０例食管胃静脉曲张出血患者２８３次急诊硬化治疗（ＥＩＳ）的经验。２３０例出血患者于出血后２４小时内行２８３次ＥＩＳ，采用５％鱼肝油酸钠或１％乙氧硬化醇，食管胃静脉内注射法。２８３例次中活动性出血２５３例次，３０例次出血已停止，首次ＥＩＳ能明确出血部位共１４２例次，为６３％（１２８／２５３）。急诊止血率为９６．４％，并发症２０例，发生率８．６％，ＥＩＳ并发症引起的死亡４例，死亡率为１．７％。ＥＩＳ是食管胃静脉曲张出血的一种有效治疗方法，适应证宽，方法简便、安全。     

药物预防食管静脉曲张硬化治疗后复发出血的临床研究

大部分肝硬化患者可并发食管静脉曲张，其中25%-35%可出现破裂出血。由于内镜及介入治疗技术的发展，急性出血的病死率已有明显下降。首次出血止血后若不进一步治疗，47%∽84%的患者在1∽2年内可再出血，病死率达20%∽70%。1994年∽2000年我们用普綦洛尔联合单硝酸异山梨酯预防食管静脉曲张破裂硬化治疗后再出血，取得满意疗效，现报道如下。     

肝硬化食管静脉曲张破裂出血内镜硬化、气囊填塞及手术疗效比较

1986年1月—1992年1月我院收治肝硬化食管静脉曲张破裂出血83例,对内镜硬化、气囊填塞压迫及手术治疗疗效进行比较。 1 对象和方法 1.1 对象 均经肝功、腹部B超及内镜证实为肝硬化食管静脉曲张破裂出血。肝功能按Child分级。本组男60例,女23例,年龄18—76岁,平均50岁,一般情况见表1。 1.2 方法 硬化治疗43例(单纯硬化30例,硬化 气囊5例,硬化 气囊 手术8例),采用5％鱼肝油酸钠血管内/或加血管旁注射,20—40ml/次,疗程3—5次,3—4点/次注射。气囊填塞(三腔二囊管)46例(单纯气囊22例,气囊 硬化3例,气囊 手术21例)。手术组29例(手术21例,手术 气囊8例),术式:断流术2例,分流 脾切除27例。所有病例随访1年以上。     

扬州地区肝硬化食管静脉曲张初次出血80例患者诊治分析

目的探讨扬州地区肝硬化食管静脉曲张初次出血患者诊治特点。方法回顾性分析2010年1月-2013年12月苏北人民医院消化内科收治的80例肝硬化食管静脉曲张初次出血患者病例资料。计数资料用率或构成比表示,率的比较采用χ2检验。结果由乙型肝炎导致肝硬化所引起的食管静脉曲张破裂出血所占比例最大;三腔二囊管临床运用可最大限度地挽救患者生命,为后期治疗提供时间;基础治疗包括止血、输血、抑酸、补液等,后期以硬化剂、套扎、硬化剂+套扎、手术、经颈静脉肝内门体分流术(TIPS)为主,但套扎运用最为广泛;患者出血初期各项指标变化有利于指导临床治疗,对患者预后具有良好的评估作用。结论扬州地区肝硬化引起的食管静脉曲张破裂出血病因呈现复杂交叉性,治疗方法仍需进一步完善,以达到个体化治疗水平;及时正确的救治,对提高临床疗效、降低病死率有重要意义;早期的健康体检,对疾病诊治起关键性的作用。     

食管静脉曲张出血的硬化治疗

我院自1994年以来,对128例食管静脉曲张破裂出血患者采用硬化止血治疗,取得满意疗效。 1.一般资料:本组128例均为我院住院患者,在入院后12～24 h内完成第1次急诊止血治疗。年龄19～73岁,平均49岁。随机分为两组。对照组(单用5％鱼肝油酸钠)68     

硬化治疗食管静脉曲张致食管穿孔一例

患者男，６７岁。因呕血４５　ｍｉｎ急诊入院，共呕血３　５００ｍｌ，入院后继续失血１　５００ｍｌ，出现休克症状。既往有乙型肝炎病史２２年，１１年前诊断为肝硬化。入院后立即给予抗休克治疗，在人工呼吸支持并大量输血基础上我们进行急诊胃镜检查，见食管及胃内有大量新鲜积血，出血灶不清，取食管下段距门齿３５　ｃｍ左右的４条曲张静脉进行硬化剂治疗，分８点注射，每点注射５～１０　ｍｌ　５％鱼肝油酸钠，总量４０　ｍｌ，高压快速注入。同时出血点上套扎１２点，术后静脉破裂出血停止，给予凝血酶１　０００单位局部喷洒，静…     

肝硬化食管静脉曲张破裂出血的内镜治疗

食管静脉曲张破裂出血是肝硬化的严重并发症。内镜治疗是预防和治疗食管静脉曲张破裂出血的主要手段之一,包括套扎术、硬化剂注射及超声内镜引导下硬化剂注射、组织胶注射、自膨式覆膜金属支架、联合治疗及其他内镜治疗方式等。现就各种内镜下治疗方式的适应证、临床疗效、并发症等情况作一概述。     

肝硬化患者食管胃底静脉曲张破裂早期再出血的危险因素分析

目的探讨影响食管胃底静脉曲张破裂出血(EGVB)患者再出血的危险因素。方法收集宁夏医科大学2006年1月-2009年12月收住入院的432例肝硬化患者,初次治疗后出血停止的325例为对照组(即出血停止组),再出血的107例为研究组(即再出血组)。分析2组患者的临床和相关检查资料。两组间计量资料的比较采用t检验,计数资料的比较采用卡方检验,并进行多个样本率间的多重比较。应用单因素非条件Logistic回归模型分析出血的影响因素。结果性别、吸烟、血红蛋白、白细胞、ALT、AST、脾脏厚度两组患者中差异有统计学意义(P0.05)。单因素非条件Logistic回归分析中性粒细胞相对值(OR=0.976,P=0.034)、白细胞计数(OR=1.173,P=0.007)、门静脉宽度(OR=7.530,P=0.001)和血红蛋白(OR=1.015,P=0.013)与出血具有相关性。结论白细胞、中性粒细胞、血红蛋白、门静脉为肝硬化食管胃底静脉曲张破裂早期再出血的危险因素。     

肝硬化食管静脉曲张的替代诊断方法

食管静脉曲张(EV)破裂出血是肝硬化最为严重的并发症之一。上消化道内镜(UGE)是诊断EV的金标准,但为侵袭性检查。目前,已经报道了很多诊断EV的替代方法,包括血清学模型、超声指标、肝脏及脾脏硬度检测、食管胶囊内镜、核磁共振和CT等。综述了这些替代方法诊断EV的准确度及其临床意义。认为超声指标(脾门指数、门静脉充血指数及血小板与脾直径比值)、脾脏硬度检测、CT和食管胶囊内镜诊断EV的准确度较高,故可考虑应用于临床实践以减少UGE的使用。     

肝硬化患者脾肝体积比与食管胃底静脉曲张的关系

目的探讨脾肝体积比在预测静脉曲张程度中的价值。方法对51例确诊的肝硬化患者进行胃镜和增强CT检查,将食管胃底静脉曲张程度分级并计算患者的脾肝体积比;比较这两个指标的相关性和各级静脉曲张患者的脾肝体积比。结果食管胃底静脉曲张的分级与脾肝体积比相关性明显(t=0.693,P<0.001)。各级食管胃底静脉曲张之间的脾肝体积比差异均有统计学意义。结论肝硬化患者随着脾肝体积比值的升高,静脉曲张程度加重,脾肝体积比可以作为无创性检测手段判断静脉曲张程度,为进一步的工作打下了一定的基础。     

Efficacy of transient elastography in screening for large esophageal varices in patients with suspicious or proven liver cirrhosis

OBJECTIVE: To evaluate the liver stiffness measurement (LSM) using transient elastography (TE) to predict the risk of esophageal varices (EVs) in Chinese patients. METHODS: In total, 46 patients with suspicious or proven liver cirrhosis underwent TE and liver biopsy. All participants were endoscopically screened for the presence of EVs and large EVs by two endoscopists who were blinded to the LSM status. Large EVs were defined as more than 5 mm in diameter. Receiver operating characteristic (ROC) curves for both TE and the platelet count/spleen diameter (PC/SD) ratio in predicting the presence of EVs or large EVs were calculated. RESULTS: Of the 46 patients, 30 (65%) had EVs including 19 (41%) with large EVs. The area under the ROC curve (AUROC) of LSM was 0.85 for the presence of EVs and 0.83 for large EVs, respectively. The cut‐off values of LSM were ≥13.4 kPa for the presence of EVs and ≥14.6 kPa for large EVs. Notably, the AUROC of the PC/SD ratio was 0.92 for the presence of EVs but only 0.69 for large EVs. CONCLUSION: LSM using TE can predict the presence of EVs or large EVs in Chinese patients with suspicious or proven cirrhosis and may identify patients who require endoscopic surveillance.     

Prognostic indicators of successful endoscopic sclerotherapy for prevention of rebleeding from oesophageal varices in cirrhosis: a long-term cohort study

Background. Although band ligation is now recommended for prevention of rebleeding from oesophageal varices in cirrhosis, sclerotherapy is still widely used. Patients submitted to chronic sclerotherapy undergo several endoscopies and experience a large number of serious complications. However, long-term outcome is poorly defined.

Aims. To assess the clinical course and prognostic indicators of patients undergoing chronic sclerotherapy for prevention of variceal rebleeding as a basis for future evaluation of long-term band ligation outcome.

Methods. Prospective cohort study prognostic analysis by the Cox proportional hazards model.

Results. A total of 218 consecutive cirrhotic patients (37 Child class A, 154 B, 27 CJ were enrolled in the study. Varices were obliterated in 139 (64%) patients in a mean of 5 (±2.6) sessions and recurred in 58/139 (41.7%) within one year. A total of 132 (60%) patients experienced 283 rebleeding episodes and 73 (33%) died. Bleeding from oesophageal ulcers was the most serious complication causing 14% of all rebleeding episodes. Significant prognostic indicators of sclerotherapy outcome were: Child-Pugh class for variceal obliteration; gastric varices and platelet count for recurrence of varices; failure to obliterate varices, variceal size and gastric varices for rebleeding; blood urea nitrogen and failure to obliterate varices for death. Presence of gastric varices was the only prognostic indicator for death in the 79 patients not achieving variceal obliteration. A mean of 10 endoscopies and of 6 hospital admissions were needed per each patient with an estimated cost of US$ 7154 per patient during the first two years of therapy.

Conclusions. Sclerotherapy is a very demanding and costly treatment, and is associated with frequent and serious side-effects. The probability of treatment failure is significantly higher in Child C patients with gastric varices. Alternative treatments should be considered for these patients.     

Evaluation of patient outcome following sclerotherapy for esophageal varices

After excluding terminally all patients, we evaluated a total of 718 patients treated with endoscopic injection sclerotherapy. They involved 350 episodes of acute hemorrhage and 368 prophylactic procedures in patients with risky varices. The 1-year cumulative survival rate was significantly lower in the acute hemorrhage group than in the prophylactic group (P<0.05). The difference in survival between the two groups was primarily due to the number of deaths in the first 2 months after sclerotherapy (20.1% vs 0.8%,P<0.0005). Improvements in the sclerotherapy technique significantly reduced the number of deaths from bleeding (9.3% vs 3.4%,P<0.05), but not those from liver failure following variceal hemorrhag. Prophylactic EIS is advantageous in the treatment of esophageal varices, i.e. it may prevent deaths fromliver failure attributed to variceal hemorrhages. The present study shows that preliminary prevention of variceal hemorrhage provides favorable hemostatic efficacy in patients with risky varices.     

Therapeutic efficacy of isosorbide dinitrate for dysphagia after endoscopic injection sclerotherapy for varices in cirrhotic patients

Background: Isosorbide dinitrate (ID) improves dysphagia of achalasia patients by lowering the low esophageal pressure. Dysphagia occurs in cirrhotic patients undergoing endoscopic injection sclerotherapy (EIS) for esophageal varices even with no structural abnormalities as its sequela. We tested whether ID can be therapeutic for dysphagia of this type. Methods: ID was given for 2–6 weeks to 13 patients with dysphagia lasting for longer than 4 weeks after EIS despite no esophagolumenal stricture on endoscopy and barium swallows. EIS was done three to six times as an injection series of ethanolamine oleate into the varices at intervals of 1–2 weeks until they were obliterated. The therapeutic efficacy of ID was evaluated by symptom severity four‐degree scorings. Esophageal transit time and emptying time were calculated from the time–activity curves on esophageal scintigraphy. Results: At 2 weeks after ID medication, dysphagia was decreased by one score in 12 of 13 patients, and by two scores in one patient. However, dysphagia at the same extent recurred in nine patients within 6 weeks after stopping ID medication, which was improved similarly by remedication. Two patients in whom dysphagia of one and two scores disappeared after ID medication dropped out because of headache. The remaining two patients remained asymptomatic for longer than 6 months after the first medication. Esophageal scintigraphy disclosed the shortening of the emptying time after ID administration in two patients. Conclusions: ID may be effective for relieving functional dysphagia after EIS for esophageal varices in cirrhotic patients.     

糖尿病对肝硬化食管静脉曲张内镜治疗后再出血影响的临床研究

目的探讨合并糖尿病是否影响肝硬化食管静脉曲张患者内镜治疗后的再出血。方法2015年6月至2018年3月,因肝硬化食管静脉曲张破裂出血在安徽医科大学第一附属医院接受内镜下静脉曲张套扎术或内镜下硬化剂注射术初次治疗的207例病例纳入回顾性分析,以术后6个月作为观察结束点统计再出血情况,根据有无出血分为出血组(n=54)和未出血组(n=153),对于可能导致术后再出血的影响因素先行单因素分析,发现差异性后再行Logistic回归分析。结果单因素分析发现,性别构成、年龄、有无门静脉血栓、有无吸烟史、有无饮酒史(P=0.05)、有无高血压、血小板计数、总胆红素水平、白蛋白水平、谷丙转氨酶水平、凝血酶原时间、食管静脉曲张程度构成、手术方式构成在出血组和未出血组间差异均无统计学意义(P均≥0.05),是否合并糖尿病、血红蛋白水平、血糖水平、腹水程度构成、肝功能分级构成在出血组和未出血组间差异均有统计学意义(P均<0.05)。将合并糖尿病(是/否)、血红蛋白水平、血糖水平、腹水程度(无-轻度/中-重度)、肝功能Child-Pugh分级(A级/B-C级)以及饮酒史(有/无)纳入多因素分析,结果显示合并糖尿病是肝硬化食管静脉曲张内镜治疗后再出血的独立危险因素(P=0.008,OR=2.973,95%CI:1.322~6.689)。结论合并糖尿病的肝硬化食管静脉曲张患者内镜治疗后易发生再出血。     

FibroTouch检测脾硬度与肝硬化患者食管胃底静脉曲张程度的相关性探讨

目的探讨瞬时弹性成像技术检查脾硬度与肝硬化患者食管胃底静脉曲张程度的相关性。方法从吉林大学第二医院2012年12月-2013年12月收治的肝硬化患者中选择拟行胃镜检查的72例进行研究,利用瞬时弹性扫描仪对患者的脾脏及肝脏硬度值进行检测,并进行胃镜检查。计数资料组间比较采用χ2检验,计量资料组间比较采用t检验,食管静脉曲张程度与脾脏硬度的相关性采用Pearson相关分析。结果随Child-Pugh分级的增加,患者的肝脏和脾脏硬度值呈不断上升的趋势。肝硬化患者的脾脏硬度值与肝脏硬度值之间呈正相关(r=0.367,P0.05)。Child-Pugh A、B、C级患者的脾脏硬度值两两间比较差异均有统计学意义(t值分别为5.149、7.231、6.119,P值分别为0.031、0.025、0.037);中度和重度食管胃底静脉曲张患者的脾脏和肝脏硬度值均出现明显增高的情况,经受试者工作特征(ROC)曲线分析,脾脏硬度值的ROC曲线下面积(AUC)、灵敏度、特异度均显著高于肝脏硬度值和PLT/脾厚度值。结论利用瞬时弹性扫描仪进行脾硬度检测与肝硬化患者的食管胃底静脉的曲张程度具有很好的相关性,且安全无创,特别适用于不适合胃镜检查的肝硬化患者。