摘要
目的:比较经皮经肝胃静脉曲张栓塞术(percutaneous transhepatic variceal embolization,PTVE)和内镜下组织胶注射术(gastric variceal obturation,GVO)治疗胃静脉曲张出血的安全性和远期疗效以及预测影响再出血和死亡的风险因素.方法:纳入肝硬化胃底静脉曲张破裂出血行PTVE或GVO患者118例,比较两种手术治疗后患者再出血率、生存率和并发症的情况,采用COX回归分析模型探讨影响再出血和死亡的独立预测因素.结果:PTVE组(n=51例)随访25.86 mo±7.67 mo,8例(15.7%)发生再出血,6例(11.8%)死亡;GOV组(n=67例)随访19.85 mo±13.12 mo,25(37.3%)例发生再出血,9例(13.4%)死亡.两组再出血率差异有统计学意义(χ2=6.723,P=0.013);PTVE组患者1年、2年、3年累计未出血发生率分别为91%、81.3%、76.7%,而GOV组患者1年、2年、3年累计未出血发生率分别为68.6%、49.5%、42.4%,差异有统计学意义(P=0.004).两组死亡率差异无统计学意义(χ2=0.073,P=0.788);PTVE组患者1年、2年、3年累计生存率分别为93.4%、89.6%、73.6%,而GOV组患者1年、2年、3年累计生存率分别为91.3%、84.9%、68.9%,差异无统计学意义(P=0.46).影响再出血发生率的因素有:治疗方式(P=0.006)、Child分级(P=0.022)、HVPG>16 mmHg(P=0.039)、脾栓或脾切(P=0.000)和红色征(P=0.003);Child分级是影响生存率唯一预测因子(P=0.001).两组并发症发生率无统计学差异(χ2=0.249,P=0.705).结论:从远期疗效看,PTVE优于内镜下组织胶注射,是安全且有效治疗胃静脉曲张的方法.
AIM： To compare the safety and long-term efficacy of percutaneous transhepatic variceal embolization（PTVE） with 2-octyl-cyanoacrylate（2-OCA） and endoscopic gastric variceal obturation（GVO） with an injection of 2-OCA for gastric variceal rebleeding, and to identify risk factors for rebleeding and mortality in gastric varices.METHODS： One hundred and eighteen patients with cirrhosis and gastric variceal bleeding were recruited. All patients underwent either endoscopic 2-OCA（GVO） or PTVE using 2-OCA. Rebleeding rate, survival rate and complications were compared between the two groups（PTVE and GVO）. COX regression analysis was used to detect possible independent predictors of variceal rebleeding and death.RESULTS： Of 51 patients who received PTVE, during the mean follow-up duration of 25.86 mo ± 17.67 mo, rebleeding occurred in 8（15.7%） patients, and 6（11.8%） patients died. Of 67 patients who received GVO, during the mean follow-up period of 19.85 months ± 13.12 months, rebleeding occurred in 25（37.3%） patients, and 9（13.4%） patientsdied. The rebleeding rates of the two groups had a significant difference（χ^2 = 6.723, P = 0.013）. The cumulative rebleeding-free rates at 1, 2 and 3 years were 91%, 81.3% and 76.7%, respectively, in the PTVE group, and 68.6%, 49.5% and 42.4%, respectively, in the GVO group（P = 0.004）. The survival rates of the two groups had no significant difference（χ^2 = 0.073, P = 0.788）. The cumulative survival rates at 1, 2 and 3 years were 93.4%, 89.6%, and 73.6%, respectively, in the PTVE group, and 91.3%, 84.9% and 68.9%, respectively, in the GVO group. The survival rates were not significantly different between the two groups（P = 0.46）. Cox analysis revealed that choice of treatment（P = 0.006）, Child-Pugh classification（P = 0.022）, HVPG 16 mmHg（P = 0.039）, partial splenic embolization or splenectomy（P = 0.000）, and red color sign（P = 0.003） were independent factors for predicting rebleeding. Child-Pugh classification was the most significant prognostic factor for survival（P = 0.001）. The incidence of complications was similar between the two groups（χ^2 = 0.249, P = 0.705）.CONCLUSION： In the long run, PTVE with 2-OCA is superior to endoscopic 2-OCA injection for preventing gastric variceal rebleeding, and PTVE with 2-OCA is considered a safe and effective method for the treatment of gastric varices.
出处
《世界华人消化杂志》
CAS
2016年第3期408-414,共7页
World Chinese Journal of Digestology
关键词
肝硬化
门静脉高压
经皮经肝胃静脉曲张栓塞术
内镜下组织胶注射术
组织黏合剂
Cirrhosis
Portal hypertension
Percutaneous transhepatic variceal embolization
Endoscopic gastric variceal obturation
Tissue adhesive
