Graffeo M, Buffoli F, Lanzani G, Donato F, Cesari P, Benedini D, Rolfi F, Paterlini A
Department of Internal Medicine, S. Orsola FBF Hospital, Brescia, Italy.
Am J Gastroenterol. 1994 Oct;89(10):1815-22.
Gastroesophageal bleeding from varices is the most life-threatening complication in liver cirrhosis with portal hypertension. Since its first application, endoscopic sclerotherapy seems to be the most widely applicable procedure to stop the bleeding and to prevent recurrences. The aim of this study was to ascertain the role of some factors as predictors of survival in different groups of cirrhotic patients.
At the time of their first hemorrhage from esophageal varices, 184 patients with portal hypertension from cirrhosis were treated by endoscopic sclerotherapy using a combined intraparavariceal procedure and Polidocanol 1% as sclerosing agent.
The follow-up range was 1-106 months (mean, 28.2 months), and 84 patients were still alive (45.7%), 97 had died (52.7%), and three had withdrawn (1.6%) at the end of the period. The major cause of death was bleeding, and 35 patients died in the first 6 wk after sclerotherapy. Using Cox proportional hazard models, Child's grading was the most important prognostic factor of both short-term (first 6 wk) and medium/long-term survival (after the first 6 wk up to 5 years). Complete eradication of varices, too, was associated with both short- and long-term survival, whereas age, sex, etiology of cirrhosis, and the presence of esophageal stenosis as a side effect of sclerotherapy were not. The type of sclerotherapy (elective vs emergent) was associated with survival, but it was not independent from Child's grade, because only patients in Child C treated electively showed a better prognosis than those treated in emergency.
We can conclude that patients with severe liver disease (Class C) have poor prognosis, and complete eradication represents an aim because it seems to be protective against the risk of dying.
门静脉高压性肝硬化患者发生的食管胃静脉曲张出血是最危及生命的并发症。自首次应用以来，内镜硬化治疗似乎是最广泛应用的止血及预防复发的方法。本研究的目的是确定某些因素在不同组肝硬化患者生存预测中的作用。
184例肝硬化门静脉高压患者首次发生食管静脉曲张出血时，采用联合曲张静脉内注射法及1%聚多卡醇作为硬化剂进行内镜硬化治疗。
随访时间为1 - 106个月（平均28.2个月），随访期末84例患者仍存活（45.7%），97例死亡（52.7%），3例退出研究（1.6%）。主要死亡原因是出血，35例患者在硬化治疗后的前6周内死亡。使用Cox比例风险模型分析，Child分级是短期（前6周）和中长期生存（6周后至5年）最重要的预后因素。静脉曲张完全消除也与短期和长期生存相关，而年龄、性别、肝硬化病因以及硬化治疗副作用导致的食管狭窄则与生存无关。硬化治疗类型（择期与急诊）与生存相关，但它并非独立于Child分级，因为仅Child C级择期治疗的患者比急诊治疗的患者预后更好。
我们可以得出结论，严重肝病（C级）患者预后较差，静脉曲张完全消除是一个目标，因为它似乎可降低死亡风险。
