胃镜下结扎及硬化介入治疗中重度食管静脉曲张的疗效及其治疗转归的影响因素分析

Efficacy of endoscopic ligation and sclerotherapy in treating moderate and severe esophageal varices and factors affecting treatment outcomes

摘要:

目的 探讨胃镜下结扎及硬化介入治疗中重度食管静脉曲张破裂出血患者的疗效及其治疗转归的影响因素。方法 本研究分为两个部分：①回顾性选取2022年5月—2023年12月四川友谊医院消化内科收治的147例中重度食管静脉曲张破裂出血患者，其中60例患者采用胃镜下结扎术治疗（对照组），另外87例患者采用胃镜下结扎+序贯硬化剂注射治疗（研究组），对比两组疗效。②回顾性选取2022年5月—2023年12月四川友谊医院消化内科采取胃镜下结扎+序贯硬化剂注射治疗的461例中重度食管静脉曲张破裂出血患者，其中治疗成功429例患者（成功组），治疗失败32例患者（失败组），对比两组患者的基线资料、临床资料等数据，分析影响治疗结局的相关因素。结果 研究组与对照组患者手术前后门静脉内径、脾静脉内径的差值比较，差异均无统计学意义（P >0.05）。研究组手术前后门静脉血流速度、门静脉血流量的差值均高于对照组（P <0.05）。研究组与对照组患者止血成功率比较，差异无统计学意义（P >0.05）。失败组患者白蛋白（ALB）、首次出血率均低于成功组，谷丙转氨酶、谷草转氨酶、静脉重度曲张患者占比、伴腹水患者占比、高血压患者占比、伴门脉血栓患者占比均高于成功组（P <0.05）。多因素一般Logistic回归分析结果显示：ALB水平降低［O^R=0.547（95% CI：0.306，0.976）］、首次出血［O^R=0.712（95% CI：0.538，0.943）］、重度胃食管静脉曲张［O^R=2.018（95% CI：1.179，3.452）］、伴腹水［O^R=1.788（95% CI：1.085，2.947）］、合并高血压［O^R=1.941（95% CI：1.106，3.406）］、伴门脉血栓［O^R=2.234（95% CI：1.239，4.031）］是中重度食管静脉曲张破裂出血患者胃镜下结扎+序贯硬化剂注射治疗止血失败的危险因素（P <0.05）。结论 胃镜下结扎及硬化介入治疗中重度食管静脉曲张破裂出血患者具有较好的止血效果，能更好地改善患者的门脉静脉血流参数；低水平ALB、多次出血、重度胃食管静脉曲张、伴有腹水、合并高血压、伴有门脉血栓是中重度食管静脉曲张破裂出血患者疗效不佳的独立危险因素。

Abstract:

Objective To explore the efficacy of endoscopic ligation and sclerotherapy in treating patients with moderate and severe esophageal variceal bleeding and factors affecting the treatment outcomes.Methods This study consisted of two parts. On the one hand, a retrospective analysis was conducted on 147 patients with moderate and severe esophageal variceal bleeding admitted to the Department of Gastroenterology at Sichuan Friendship Hospital from May 2022 to December 2023. Among them, 60 patients were treated with endoscopic ligation (control group), while the other 87 patients were treated with endoscopic ligation and sequential sclerotherapy (study group). The therapeutic effects of the two groups were compared. On the other hand, a retrospective analysis was also conducted on 461 patients with moderate and severe esophageal variceal bleeding who underwent gastroscopic ligation and sequential sclerotherapy at the Department of Gastroenterology of Sichuan Friendship Hospital from May 2022 to December 2023. Among them, 420 patients achieved successful treatment (success group) and 42 patients experienced treatment failure (failure group). Baseline characteristics, disease profiles, and other data were compared between the two groups, and factors influencing treatment outcomes were analyzed.Results The differences of portal vein diameter and splenic vein diameter before and after the surgery were not different between the study group and the control group (P > 0.05). The differences of the flow velocity of portal vein and the portal venous flow before and after the surgery in the study group were higher than those in the control group (P < 0.05). The success rate of hemostasis in the study group was not different from that in the control group (P > 0.05). The ALB level and the rate of a first bleeding episode in the failure group were lower than those in the success group, whereas the proportion of severe esophageal varices, the proportion of patients with ascites, the proportion of patients with hypertension, and the proportion of patients with portal vein thrombosis in the failure group were higher than those in the success group (P < 0.05). The multivariable Logistic regression analysis revealed that decreased ALB levels [O^R = 0.547 (95% CI: 0.306, 0.976) ], first bleeding episode [O^R = 0.712 (95% CI: 0.538, 0.943) ], severe esophageal varices [O^R = 2.018 (95% CI: 1.179, 3.452) ], presence of ascites [O^R = 1.788 (95% CI: 1.085, 2.947) ], presence of hypertension [O^R = 1.941 (95% CI: 1.106, 3.406) ], and presence of portal vein thrombosis [O^R = 2.234 (95% CI: 1.239, 4.031) ] were factors contributing to hemostatic failure in patients with moderate and severe esophageal variceal bleeding treated with gastroscopic ligation and sequential sclerotherapy (P < 0.05).Conclusions Endoscopic ligation and sclerotherapy demonstrate effective hemostasis in patients with moderate and severe esophageal variceal bleeding and significantly improve portal venous blood flow parameters. Low ALB levels, recurrent bleeding, severe esophageal varices, presence of ascites, comorbid hypertension, and portal vein thrombosis are identified as independent risk factors for poor treatment outcomes in these patients.