摘要
目的探讨内镜下套扎联合硬化剂治疗肝细胞肝癌(HCC)并发食管胃底静脉曲张破裂出血(EGVB)的临床疗效,并分析术后再出血的影响因素。方法收集106例HCC并发EGVB患者的临床资料,比较内镜下套扎联合硬化剂治疗不同类型EGVB的临床疗效,采用非条件多因素Logistic回归模型分析患者术后再出血的影响因素。结果HCC并发3种类型EGVB患者的止血成功率均为100%;治疗30天后,HCC并发3种类型EGVB患者的再出血率比较,差异均无统计学意义(P﹥0.05);HCC并发EGVBⅠ型患者的静脉曲张消失率高于HCC并发EGVBⅡ型、EGVBⅢ型患者,静脉曲张复发率低于HCC并发EGVBⅡ型、EGVBⅢ型患者,差异均有统计学意义(P﹤0.05)。非条件多因素Logistic回归分析结果显示,Child-Pugh分级、合并腹腔积液、门静脉直径、白蛋白、红色征均是HCC并发EGVB患者治疗后再出血的独立影响因素(P﹤0.05)。术后6个月内,HCC并发EGVBⅠ型、Ⅱ型及Ⅲ型患者均无食管狭窄、食管穿孔、胸腔积液及异位栓塞等严重并发症。结论内镜下套扎联合硬化剂治疗HCC并发EGVB患者的止血率为100%,其对不同类型的EGVB患者均具有较好的治疗效果。HCC并发EGVB患者治疗后再出血的独立影响因素较多,临床医师可依据独立影响因素对患者进行合理干预,降低再出血发生率,改善患者预后。
Objective To explore the clinical efficacy of endoscopic loop ligation combined with sclerosing agent in the treatment of hepatocellular carcinoma(HCC)complicated with esophageal gastric varices bleeding(EGVB),and ana-lyze the influencing factors of postoperative rebleeding.Method The clinical data of 106 patients with HCC complicat-ed with EGVB were collected.The clinical efficacy of endoscopic loop ligation combined with sclerosing agent in the treatment of different types of EGVB was compared.The multivariate Logistic regression model was used to analyze the related factors that affect the patient’s postoperative rebleeding.Result The success rate of hemostasis in the HCC pa-tients with three types of EGVB were all 100%.After treatment for 30 days,there was no significant difference in the re-bleeding rate among the HCC patients with three types of EGVB(P>0.05).The disappearance rate of varicose veins in HCC patients with EGVB type I was significantly higher than that in HCC patients with EGVB type II and EGVB type III,and the recurrence rate of varicose veins was significantly lower than that of HCC patients with EGVB type II and EGVB type III,the differences were statistically significant(P<0.05).The unconditional multivariate Logistic regression analysis showed that Child-Pugh classification,combination of ascites,diameter of portal vein,albumin,and red sign were independent factors that affect the postoperative rebleeding of HCC patients with EGVB(P<0.05).Patients with HCC complicated with EGVB type I,type II,and type III had no serious complications such as esophageal stenosis,esophageal perforation,pleural effusion,and ectopic embolism within 6 months after surgery.Conclusion Hemostatic rate of endoscopic loop ligation combined with sclerosing agent in the treatment of patients with HCC complicated with EGVB was 100%,and the treatment effect is satisfactory for different types of EGVB.There are many independent fac-tors that affect rebleeding after treatment of HCC patients with EGVB.Clinicians can carry out reasonable interventions for patients to reduce the incidence of rebleeding to ensure the prognosis.
作者
安然
李琤
李广明
魏义胜
AN Ran;LI Cheng;LI Guangming;WEI Yisheng(The Second Department of Critical Medicine,Zhengzhou Sixth People’s Hospital,Zhengzhou 450000,He’nan,China;Department of Liver Cirrhosis,Zhengzhou Sixth People’s Hospital,Zhengzhou 450000,He’nan,China)
出处
《癌症进展》
2022年第1期63-66,共4页
Oncology Progress
关键词
内镜
硬化剂
肝细胞肝癌
食管胃底静脉曲张破裂出血
endoscopy
sclerosing agent
hepatocellular carcinoma
esophageal gastric varices bleeding
