肝硬化食管静脉曲张结扎术后早期再出血危险因素分析

目的探讨内镜下食管静脉曲张结扎术(EVL)后早期再出血的临床危险因素。方法总结2005年1月—2012年12月肝硬化食管静脉曲张单纯EVL治疗患者320例的资料,统计其性别、年龄、肝硬化原因、合并症、是否患肝癌、相关手术史、实验室检查、影像学结果、胃镜结果等因素对术后早期再出血发生率和患者预后的影响,寻找独立危险因素。结果多元逐步Logistic回归分析显示:中量至大量腹水(OR=60.21,95%CI 10.10～415.35,P<0.01)、结扎点数(OR=16.28,95%CI 5.05～76.28,P<0.01)、静脉曲张程度(OR=14.96,95%CI 3.84～77.49,P<0.05)和凝血酶原时间(PT)>18 s(OR=12.26,95%CI 1.85～67.65,P<0.05)是肝硬化食管静脉曲张结扎术后早期再出血的独立危险因素。结论对肝硬化食管静脉曲张结扎术后早期再出血的独立危险因素术前应予积极的治疗及预防。

Analysis risk factors of ligation of esophageal varices in cirrhosis early rebleeding

Objective To analyze the clinical risk factors for early variceal re-bleeding after endoscopic variceal ligation （EVL）. Methods 320 cirrhotic patients with esophageal varices who received elective EVL to prevent bleeding or rebleeding at our endoscopy center were enrolled between Jan,2005 and Dec,2012. In order to discover independent risk factors, a lot of items were analyzed, including comorbidities, liver cirrhosis, liver cancer, whether due to shunt, de-vascularization and splenectomy history, laboratory findings, imaging, endoscope. Results Stepwise multivariate Logistic regression analysis showed that four variables were independent risk factors for early re-bleeding： moderate to excessive ascites （ OR = 60.21, 95% CI 10.10 ～ 415.35, P 〈 0.01 ）, the number of bands placed （ oR = 16.28, 95% CI 5.05 ～ 76.28, P 〈 0.01 ）, the extent of varices （ OR = 14.96, 95% CI 3.84 ～ 77.49, P 〈 0.05） and pro-thrombin time 〉 18 s （ OR = 12.26, 95% CI 1.85 ～ 67.65, P 〈 0.05 ）. Conclusion The early re-bleeding rate after EVL is effected by the ascites （ moderate to exces- sive）, the number of rubber bands, the extent of esophageal varies and the pro-thrombin time 〉 18 s, effective measures for prevention and treatment should be adopted before EVL.