背景:胃底静脉曲张破裂出血通常更严重,可能是致命的。目前,胃底静脉曲张出血治疗的国际共识建议因内镜分类而异.很少有研究研究结扎与胃静脉曲张闭塞(GVO)治疗胃静脉曲张。
方法:本研究纳入了2016年1月至2020年12月河北医科大学第二医院收治的79例肝硬化食管胃底静脉曲张出血患者。其中,42例患者纳入强化胃静脉曲张套扎术(IGVL)组,GVO组包括37例。我们进行了一项回顾性队列研究,以分析这两种治疗方法的有效性和安全性。
结果:IGVL组初次治疗后再出血率明显低于GVO组(23.8%vs.48.6%,P<0.05)。总死亡率无显著组间差异(14.3%vs.32.4%),6周死亡率(0.0%vs.2.7%),或1年死亡率(11.9%vs.13.5%,所有P>0.05)。GVO组的>1年死亡率和出血相关死亡率明显高于IGVL组(23.3%vs.2.7%,P<0.05;27.0%vs.9.5%,P<0.05)。IGVL组的不良事件发生率为57.1%,GVO组为48.6%,差异无统计学意义(P>0.05)。初次治疗后再出血的独立预测因素是使用GVO作为内镜治疗,总胆红素>17.1µmol/L,肝癌,和糖尿病。对于死亡率,独立预测因素是男性,肝癌,腹水,初次治疗后再出血。
结论:初次治疗后再出血的发生率低于GVO。初次治疗后再出血的独立预测因素为内镜治疗方法,总胆红素>17.1µmol/L,肝癌,和糖尿病。对于死亡率,独立预测因素是男性,肝癌,腹水,初次治疗后再出血。
BACKGROUND: Gastric variceal bleeding is often more serious and can be fatal. Currently, international consensus recommendations for the treatment of gastric variceal bleeding vary according to endoscopic classification. Few studies have investigated ligation versus gastric variceal obturation (GVO) for the treatment of gastric varices.
METHODS: The
study included 79 patients with cirrhosis-induced bleeding from esophageal and fundal varices who were treated at the Second Hospital of Hebei Medical University between January 2016 and December 2020 and who met the inclusion criteria. Among them, 42 patients were included in the intensive gastric varices ligation (IGVL) group, and 37 were included in the GVO group. We conducted a retrospective cohort
study to analyze the effectiveness and safety of these 2 treatments.
RESULTS: The rebleeding rate after initial treatment was significantly lower in the IGVL group than in the GVO group (23.8% vs. 48.6%, P<0.05). No significant between-group difference was observed in overall mortality (14.3% vs. 32.4%), 6-week mortality (0.0% vs. 2.7%), or 1-year mortality (11.9% vs. 13.5%, all P>0.05). The >1-year mortality and bleeding-related mortality rates were significantly higher in the GVO group than in the IGVL group (23.3% vs. 2.7%, P<0.05; 27.0% vs. 9.5%, P<0.05). The incidence of adverse events was 57.1% in the IGVL group and 48.6% in the GVO group, with no significant difference (P>0.05). Independent predictors for rebleeding after initial treatment were the use of GVO as endoscopic treatment, total bilirubin >17.1 µmol/L, liver cancer, and diabetes. For mortality, the independent predictors were male sex, liver cancer, ascites, and rebleeding after initial treatment.
CONCLUSIONS: Rebleeding after initial treatment was lower after IGVL than GVO. Independent predictors for rebleeding after initial treatment were endoscopic treatment method, total bilirubin >17.1 µmol/L, liver cancer, and diabetes. For mortality, the independent predictors were male sex, liver cancer, ascites, and rebleeding after initial treatment.