Hori Shinichiro, Takaki Akinobu, Okada Hiroyuki, Fujiwara Akiko, Takenaka Ryuta, Makidono Chiho, Shiratori Yasushi
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
J Gastroenterol Hepatol. 2006 Nov;21(11):1704-9. doi: 10.1111/j.1440-1746.2006.04267.x.
Bleeding from esophageal varices is one of the frequent severe complications arising in patients with liver cirrhosis. The management of esophageal varices is therefore important for patient survival. The purpose of this study was to clarify the predictive factors for mortality in patients with Child C cirrhosis presenting with variceal bleeding.
A retrospective analysis of 77 Child C cirrhotic patients with bleeding from esophageal varices was conducted. All patients received endoscopic therapy. Twenty-nine patients received endoscopic variceal ligation, and 48 patients received endoscopic injection sclerotherapy or endoscopic injection sclerotherapy with ligation. Univariate and multivariate analyses of clinical data were performed to identify the prognostic factors for survival for these 77 patients.
Fifty-seven of 77 patients received endoscopic therapy within 24 h after variceal bleeding, and bleeding was controlled in 55 (96.5%). The remaining 20 patients received endoscopic therapy more than 24 h after bleeding. Higher bilirubin level and rebleeding were the predictive parameters for 6-week survival in the 77 patients, according to univariate and multivariate analysis. Higher bilirubin level, refractory ascites, and the presence of hepatocellular carcinoma were the predictive parameters for mortality in 77 patients as determined by multivariate analysis.
Endoscopic therapy was effective in controlling acute variceal bleeding of Child C cirrhotic patients. The prognosis of Child C stage patients presenting with variceal bleeding depended on the severity of liver damage and the presence of hepatocellular carcinoma.
食管静脉曲张出血是肝硬化患者常见的严重并发症之一。因此，食管静脉曲张的治疗对患者生存至关重要。本研究旨在阐明Child C级肝硬化伴静脉曲张出血患者的死亡预测因素。
对77例Child C级肝硬化伴食管静脉曲张出血的患者进行回顾性分析。所有患者均接受内镜治疗。29例患者接受内镜下静脉曲张结扎术，48例患者接受内镜下硬化剂注射或内镜下硬化剂注射联合结扎术。对临床数据进行单因素和多因素分析，以确定这77例患者的生存预后因素。
77例患者中有57例在静脉曲张出血后24小时内接受了内镜治疗，其中55例（96.5%）出血得到控制。其余20例患者在出血后24小时以上接受了内镜治疗。单因素和多因素分析显示，较高的胆红素水平和再出血是这77例患者6周生存的预测参数。多因素分析确定，较高的胆红素水平、难治性腹水和肝细胞癌的存在是这77例患者死亡的预测参数。
内镜治疗对控制Child C级肝硬化患者的急性静脉曲张出血有效。Child C期静脉曲张出血患者的预后取决于肝损伤的严重程度和肝细胞癌的存在情况。
