Li J X, Li Z J, Zhang H M, Xu S S, Quan R Z, Zhang H, Lu M M, Wang X Y, Ma S, Mi J, Ding H, Li X L
Department of Gastroenterology, People's Hospital of Zhengzhou University, Zhengzhou 450003, China.
Department of Gastroenterology, Henan Provincial People's Hospital, Zhengzhou 450003, China.
Zhonghua Yi Xue Za Zhi. 2024 Mar 5;104(9):682-689. doi: 10.3760/cma.j.cn112137-20231110-01064.
To investigate the association between portal vein thrombosis and rebleeding after non-urgent endoscopic treatment of esophagogastric varices. The cirrhotic patients with esophagogastric varices diagnosed in the People's Hospital of Zhengzhou University from January 2017 to March 2023 were retrospectively collected. The patients were divided into thrombotic group and non-thrombotic group according to the presence or absence of portal vein thrombosis. The failure rate of endoscopic treatment and rebleeding rate in different periods were compared between the two groups. Receiver operating characteristic (ROC) curve was used to select the best cutoff value of gastric varicose diameter that affected total rebleeding during follow-up in both groups. The influencing factors of rebleeding within 12 and 36 months in both groups were analyzed, and the influencing factors of rebleeding within 36 months in thrombus group were further analyzed. A total of 106 patients were enrolled, including 53 patients in the thrombotic group [male 37, female 16, aged 18-78 (54±13) years] and 53 patients in the non-thrombotic group [male 37, female 16, aged 27-83 (55±12) years]. The follow-up time of the two groups were (20±15) and (25±15) months, respectively. The total rebleeding rate in the thrombotic group was higher than that in the non-thrombotic group [30.2% (16/53) vs 13.2% (7/53), ˂0.05]. The rebleeding rates within 6, 12, 24 and 36 months in the thrombotic group were higher than those in the non-thrombotic group [18.9% (10/53) vs 5.7% (3/53), 18.9% (10/53) vs 5.7% (3/53), 28.3% (15/53) vs 9.4% (5/53), 30.2% (16/53) vs 11.3% (6/53), all ˂0.05]. The best cut-off value of the diameter of gastric varices that affects the total rebleeding in the two groups was 10.4 mm (10 mm was selected as the best cut-off value for the convenience of practical clinical application). Hemoglobin ˂ 85 g/L (=0.202, 95%: 0.043-0.953, =0.043), 10 mm ˂ the diameter of GV ≤ 15 mm (=5.321, 95%: 1.161-24.390, =0.031) and endoscopic variceal ligation combined with endoscopic tissue adhesive injection (EVL+ETAI) (=7.172, 95%: 1.910-26.930, =0.004) were the risk factors for the first gastroesophageal variceal rebleeding within 12 months after non-urgent endoscopic treatment. EVL+ETAI (=3.811, 95%: 1.441-10.084, =0.007) and portal vein thrombosis (=4.026, 95%: 1.483-10.932, =0.006) were the risk factors for the first gastroesophageal variceal rebleeding within 36 months after non-urgent endoscopic treatment. The study found that, 10 mm ˂ the diameter of GV ≤ 15 mm (=7.503, 95%: 1.568-35.890, =0.012) was the risk factor for rebleeding within 36 months in the thrombotic group. Portal vein thrombosis is a risk factor for rebleeding after non-urgent endoscopic treatment of esophagogastric varices.
探讨非急诊内镜治疗食管胃静脉曲张后门静脉血栓形成与再出血之间的关联。回顾性收集2017年1月至2023年3月在郑州大学人民医院诊断为食管胃静脉曲张的肝硬化患者。根据是否存在门静脉血栓形成将患者分为血栓形成组和非血栓形成组。比较两组不同时期内镜治疗失败率和再出血率。采用受试者工作特征（ROC）曲线选择影响两组随访期间总再出血的胃静脉曲张直径的最佳截断值。分析两组12个月和36个月内再出血的影响因素，并进一步分析血栓形成组36个月内再出血的影响因素。共纳入106例患者，其中血栓形成组53例[男性37例，女性16例，年龄18 - 78岁（54±13岁）]，非血栓形成组53例[男性37例，女性16例，年龄27 - 83岁（55±12岁）]。两组的随访时间分别为（20±15）个月和（25±15）个月。血栓形成组的总再出血率高于非血栓形成组[30.2%（16/53）对13.2%（7/53），˂0.05]。血栓形成组6个月、12个月、24个月和36个月时的再出血率均高于非血栓形成组[18.9%（10/53）对5.7%（3/53），18.9%（10/53）对5.7%（3/53），28.3%（15/53）对9.4%（5/53），30.2%（16/53）对11.3%（6/53），均˂0.05]。影响两组总再出血的胃静脉曲张直径的最佳截断值为10.4 mm（为便于临床实际应用，选择10 mm作为最佳截断值）。血红蛋白˂85 g/L（=0.202，95%：0.043 - 0.953，=0.043）、10 mm˂胃静脉曲张直径≤15 mm（=5.321，95%：1.161 - 24.390，=0.031）和内镜下静脉曲张套扎联合内镜组织粘合剂注射（EVL + ETAI）（=7.172，95%：1.910 - 26.930，=0.004）是非急诊内镜治疗后12个月内首次食管胃静脉曲张再出血的危险因素。EVL + ETAI（=3.811，95%：1.441 - 10.084，=0.007）和门静脉血栓形成（=4.026，95%：1.483 - 10.932，=0.006）是非急诊内镜治疗后36个月内首次食管胃静脉曲张再出血的危险因素。研究发现，10 mm˂胃静脉曲张直径≤15 mm（=7.503，95%：1.568 - 35.890，=0.012）是血栓形成组36个月内再出血的危险因素。门静脉血栓形成是非急诊内镜治疗食管胃静脉曲张后再出血的危险因素。
