一项关于强化胃静脉曲张结扎与内镜胃静脉曲张闭塞治疗胃静脉曲张出血的回顾性队列研究。

A retrospective cohort study of intensive gastric variceal ligation versus endoscopic gastric variceal obturation in the management of gastric variceal bleeding.

机构信息

Department of Gastroenterology, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.

Department of Nutrition, Shijiazhuang Maternity and Child Healthcare Hospital, Shijiazhuang, China.

出版信息

Ann Palliat Med. 2022 Mar;11(3):1038-1047. doi: 10.21037/apm-22-138.

DOI:10.21037/apm-22-138

PMID:35365033

Abstract

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.

摘要

背景

胃静脉曲张出血通常更为严重，可能危及生命。目前，国际共识推荐的胃静脉曲张出血治疗方法因内镜分类而异。很少有研究调查套扎与胃静脉曲张闭塞（GVO）治疗胃静脉曲张的效果。

方法

本研究纳入了 2016 年 1 月至 2020 年 12 月在河北医科大学第二医院接受治疗的肝硬化引起的食管和胃底静脉曲张出血且符合纳入标准的 79 例患者。其中，42 例患者纳入密集胃静脉曲张结扎（IGVL）组，37 例患者纳入 GVO 组。我们进行了回顾性队列研究，以分析这两种治疗方法的有效性和安全性。

结果

初始治疗后再出血率在 IGVL 组显著低于 GVO 组（23.8%比 48.6%，P<0.05）。两组患者的总死亡率（14.3%比 32.4%）、6 周死亡率（0.0%比 2.7%）或 1 年死亡率（11.9%比 13.5%）均无显著差异（均 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%比 2.7%，P<0.05；27.0%比 9.5%，P<0.05）。IGVL 组不良事件发生率为 57.1%，GVO 组为 48.6%，差异无统计学意义（P>0.05）。初始治疗后再出血的独立预测因素为 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，独立预测因素为男性、肝癌、腹水和初始治疗后再出血。