Paik Chang Nyol, Kim Sang Woo, Lee In Seok, Park Jae Myung, Cho Yu Kyung, Choi Myung Gyu, Chung In Sik
Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
J Clin Gastroenterol. 2008 Sep;42(8):916-22. doi: 10.1097/MCG.0b013e31811edcd1.
Cyanoacrylate has been recommended for the treatment of gastric variceal bleeding.
We aimed to evaluate the efficacy and safety of cyanoacrylate injection therapy in patients with gastric variceal bleeding, and to identify the factors predictive of failure, rebleeding, and survival after therapy.
One hundred twenty-one patients with gastric variceal bleeding who received cyanoacrylate injections were retrospectively reviewed.
Treatment succeeded in 110 patients (90.9%). Rebleeding and mortality rate during 4-week were 13.2% and 11.6%. A stepwise logistic regression analysis indicated that only the Child-Pugh class was an independent predictive factor of treatment failure [Child-Pugh C vs. Child-Pugh A and B, odds ratio (OR), 5.0; 95% confidence interval (CI), 1.2-19.4; P=0.025]. The actuarial probability of a 4-week absence of rebleeding and survival after the initial therapy was 86.8% and 85.1%, respectively. A stepwise logistic regression analysis showed that a Child-Pugh class C and hepatocellular carcinoma were independent predictive factors for rebleeding (OR, 7.4; 95% CI, 2.0-27.0; P=0.003 and OR, 3.3; 95% CI, 1.0-11.1; P=0.05, respectively) and mortality (OR, 7.4; 95% CI, 2.0-27.0; P=0.003 and OR, 3.3; 95% CI, 1.0-11.1; P=0.05, respectively). Only 2 cases (2.7%) with serious complications, noted as cyanoacrylate embolisms, were observed. At 1-year follow up, the actuarial probability of remaining free of bleeding was 49.0% and hepatitis B virus infection was independent predictive factor of bleeding (OR, 5.3; 95% CI, 1.4-20.0; P=0.015).
In short-term follow-up, cyanoacrylate injection is an effective treatment method for gastric variceal bleeding and the Child-Pugh class was only independent predictive factor of treatment failure and the Child-Pugh class and the hepatocellular carcinoma were risk factors for rebleeding and survival. In long-term follow-up, the presence of hepatitis B infection was risk factor for rebleeding.
氰基丙烯酸酯已被推荐用于治疗胃静脉曲张出血。
我们旨在评估氰基丙烯酸酯注射疗法治疗胃静脉曲张出血患者的疗效和安全性，并确定治疗失败、再出血和治疗后生存的预测因素。
对121例接受氰基丙烯酸酯注射治疗的胃静脉曲张出血患者进行回顾性分析。
110例患者（90.9%）治疗成功。4周内再出血率和死亡率分别为13.2%和11.6%。逐步逻辑回归分析表明，只有Child-Pugh分级是治疗失败的独立预测因素[Child-Pugh C级与Child-Pugh A级和B级相比，比值比（OR）为5.0；95%置信区间（CI）为1.2 - 19.4；P = 0.025]。初始治疗后4周无再出血和生存的精算概率分别为86.8%和85.1%。逐步逻辑回归分析显示，Child-Pugh C级和肝细胞癌是再出血（OR分别为7.4；95% CI为2.0 - 27.0；P = 0.003和OR为3.3；95% CI为1.0 - 11.1；P = 0.05）和死亡（OR分别为7.4；95% CI为2.0 - 27.0；P = 0.003和OR为3.3；95% CI为1.0 - 11.1；P = 0.05）的独立预测因素。仅观察到2例（2.7%）出现严重并发症，表现为氰基丙烯酸酯栓塞。在1年随访时，无出血的精算概率为49.0%，乙型肝炎病毒感染是出血的独立预测因素（OR为5.3；95% CI为1.4 - 20.0；P = 0.015）。
在短期随访中，氰基丙烯酸酯注射是治疗胃静脉曲张出血的有效方法，Child-Pugh分级是治疗失败的唯一独立预测因素，Child-Pugh分级和肝细胞癌是再出血和生存的危险因素。在长期随访中，乙型肝炎感染的存在是再出血的危险因素。
