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吴玲, 王三强, 艾英杰, 等. 食管胃腔外血管对内镜预防食管胃静脉曲张再出血的影响[J]. 中国临床医学, 2024, 31(3): 347-352. DOI: 10.12025/j.issn.1008-6358.2024.20240606
引用本文: 吴玲, 王三强, 艾英杰, 等. 食管胃腔外血管对内镜预防食管胃静脉曲张再出血的影响[J]. 中国临床医学, 2024, 31(3): 347-352. DOI: 10.12025/j.issn.1008-6358.2024.20240606
WU Ling, WANG Sanqiang, AI Yingjie, et al. Para-esophageal and para-gastric vessels affect the secondary prophylactic efficacy of endoscopic treatment for varices[J]. Chinese Journal of Clinical Medicine, 2024, 31(3): 347-352. DOI: 10.12025/j.issn.1008-6358.2024.20240606
Citation: WU Ling, WANG Sanqiang, AI Yingjie, et al. Para-esophageal and para-gastric vessels affect the secondary prophylactic efficacy of endoscopic treatment for varices[J]. Chinese Journal of Clinical Medicine, 2024, 31(3): 347-352. DOI: 10.12025/j.issn.1008-6358.2024.20240606

食管胃腔外血管对内镜预防食管胃静脉曲张再出血的影响

Para-esophageal and para-gastric vessels affect the secondary prophylactic efficacy of endoscopic treatment for varices

  • 摘要:
    目的 探讨食管和胃腔外血管对内镜预防食管胃静脉曲张再出血的影响。
    方法 回顾性分析2020年1月至2020年12月在复旦大学附属中山医院因肝硬化食管胃静脉曲张出血,接受肝静脉压力梯度(HVPG)检测并行内镜下套扎和(或)组织胶注射预防再出血的患者。根据门静脉CT显示的食管和胃腔外血管情况,将患者分为有腔外血管团组和无腔外血管团组,评价内镜治疗后2年内再出血情况。
    结果 共纳入69例患者,其中27例合并腔外血管团。两组患者一般基线资料、血液学指标(血红蛋白水平、凝血酶原时间、白蛋白水平)、HVPG、手术方式差异均无统计学意义。2年内共25例发生再出血,包括有腔外血管团组15例、无腔外血管团组10例。Kaplan-Meier生存分析显示,有腔外血管团组内镜治疗后的2年内累积再出血率高于无腔外血管团组(60.07% vs 32.79%,P=0.022)。多因素Cox回归分析显示,有腔外血管团是食管胃静脉曲张出血患者内镜治疗后再出血的独立预测因素(HR=2.33, 95% CI 1.01~5.39, P=0.047)。
    结论 存在食管胃腔外血管团能独立预测内镜治疗后食管胃静脉曲张再出血,建议食管胃静脉曲张出血患者接受内镜预防再出血时,通过门静脉CT评估食管和胃腔外血管情况;对于合并巨大腔外血管团患者,建议充分评估后采用经颈静脉门体分流术等方法,或根据密切随访结果及时调整内镜治疗策略。

     

    Abstract:
    Objective To evaluate the effect of para-esophageal and para-gastric vessels (PEPGV) on endoscopic secondary prophylaxis for varices.
    Methods The clinical data of patients with cirrhosis-related esophagogastric varices (EGV) who underwent endoscopic variceal ligation and/or obliteration, and had hepatic venous pressure gradient (HVPG) result between January 2020 and December 2020 in Zhongshan Hospital, Fudan University were retrospectively analyzed. Patients were divided into a group without PEPGV and a group with PEPGV based on CT imaging of the portal vein. The main outcome was 2-year re-bleeding.
    Results A total of 69 patients were included, and 27 of them had PEPGV. There was no statistical difference in baseline characteristics, blood indexes (included hemoglobin level, prothrombin time and albumin level), HVPG, and the secondary prophylactic endoscopic treatment ways between the two groups. A total of 25 patients experienced re-bleeding within 2 years after endoscopic treatment, including 15 in the group with PEPGV and 10 in the group without PEPGV. Kaplan-Meier analysis showed that the cumulative 2-year re-bleeding rate was significantly higher in the group with PEPGV than in the group without PEPGV (60.07% vs 32.79%, P=0.022). Further multivariate Cox analysis showed that PEPGV was an independent predictor of re-bleeding after endoscopic treatment in EGV patients (HR=2.33, 95% CI 1.01-5.39, P=0.047).
    Conclusions The PEPGV is an independent predictor of re-bleeding after endoscopic treatment in EGV patients. It is suggested that when patients with EGV receive endoscopic treatment to prevent re-bleeding, portal vascular CT is suggested to evaluate PEPGV. For patients with giant extraluminal vascular masses, fully evaluating other treatment options such as transjugular intrahepatic portosystemic shunt, or adjusting endoscopic treatment ways is recommended.

     

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