Balanzó J, Such J, Sainz S, González D, Guarner C, Allende L, Lacalle J P, Vilardell F
Escuela de Patologé Digestiva, Hospital Santa Creu i Sant Pau, Barcelona.
Surg Gynecol Obstet. 1990 Dec;171(6):489-92.
Of 197 consecutive patients with cirrhosis admitted because of bleeding from esophageal varices, 133 were included in a prospective study of elective sclerotherapy. We evaluated the incidence of extensive rebleeding and mortality rate. The period of study was 54 months and the mean follow-up period was 21 months. Forty-one patients had severe rebleeding and a majority of the episodes occurred during the first year. Only four patients had more than five sessions of sclerosis when rebleeding occurred. The probability rate for patients to be free of severe rebleeding after 48 months, according to Pugh's classification, was 88 per cent for those with grade A, 50 percent for grade B and 43 percent for grade C. The over-all mortality rate was 38.8 per cent (53 patients), with the highest rate noted during the first year. The mortality rate of patients with severe rebleeding was much higher than that of those who did not rebleed. Kaplan-Meier survival analysis at four years was 52 per cent, and survival rates in relation to Pugh's classification were 73 per cent for A, 53 per cent for B and 34 per cent for C. Differences between the three groups were statistically significant. Therefore, because of the high mortality rate associated with patients with cirrhosis and extensive rebleeding during the first year, it is important to achieve, as soon as possible, eradication of esophageal varices.
在197例因食管静脉曲张出血而入院的肝硬化患者中，133例被纳入择期硬化疗法的前瞻性研究。我们评估了广泛再出血的发生率和死亡率。研究期为54个月，平均随访期为21个月。41例患者发生严重再出血，且大多数发作发生在第一年。再出血发生时，只有4例患者接受了超过5次硬化治疗。根据Pugh分类，48个月后患者无严重再出血的概率，A级为88%，B级为50%，C级为43%。总死亡率为38.8%（53例患者），第一年死亡率最高。严重再出血患者的死亡率远高于未再出血患者。四年的Kaplan-Meier生存分析显示生存率为52%，与Pugh分类相关的生存率，A级为73%，B级为53%，C级为34%。三组之间的差异具有统计学意义。因此，由于肝硬化患者第一年与广泛再出血相关的高死亡率，尽快根除食管静脉曲张很重要。
