中国临床医学2024，Vol.31Issue(3)：347-352,6.DOI:10.12025/j.issn.1008-6358.2024.20240606
食管胃腔外血管对内镜预防食管胃静脉曲张再出血的影响
Para-esophageal and para-gastric vessels affect the secondary prophylactic efficacy of endoscopic treatment for varices
摘要
Abstract
Objective To evaluate the effect of para-esophageal and para-gastric vessels(PEPGV)on endoscopic secondary prophylaxis for varices.Methods The clinical data of patients with cirrhosis-related esophagogastric varices(EGV)who underwent endoscopic variceal ligation and/or obliteration,and had hepatic venous pressure gradient(HVPG)result between January 2020 and December 2020 in Zhongshan Hospital,Fudan University were retrospectively analyzed.Patients were divided into a group without PEPGV and a group with PEPGV based on CT imaging of the portal vein.The main outcome was 2-year re-bleeding.Results A total of 69 patients were included,and 27 of them had PEPGV.There was no statistical difference in baseline characteristics,blood indexes(included hemoglobin level,prothrombin time and albumin level),HVPG,and the secondary prophylactic endoscopic treatment ways between the two groups.A total of 25 patients experienced re-bleeding within 2 years after endoscopic treatment,including 15 in the group with PEPGV and 10 in the group without PEPGV.Kaplan-Meier analysis showed that the cumulative 2-year re-bleeding rate was significantly higher in the group with PEPGV than in the group without PEPGV(60.07％vs 32.79％,P=0.022).Further multivariate Cox analysis showed that PEPGV was an independent predictor of re-bleeding after endoscopic treatment in EGV patients(HR=2.33,95％CI 1.01-5.39,P=0.047).Conclusions The PEPGV is an independent predictor of re-bleeding after endoscopic treatment in EGV patients.It is suggested that when patients with EGV receive endoscopic treatment to prevent re-bleeding,portal vascular CT is suggested to evaluate PEPGV.For patients with giant extraluminal vascular masses,fully evaluating other treatment options such as transjugular intrahepatic portosystemic shunt,or adjusting endoscopic treatment ways is recommended.关键词
食管胃腔外血管/肝硬化/食管胃静脉曲张/内镜治疗/再出血Key words
para-esophageal and para-gastric vessels/cirrhosis/esophagogastric varices/endoscopic treatment/re-bleeding分类
医药卫生引用本文复制引用
吴玲,王三强,艾英杰,黄晓铨,李锋,陈世耀..食管胃腔外血管对内镜预防食管胃静脉曲张再出血的影响[J].中国临床医学,2024,31(3):347-352,6.基金项目
上海市自然科学基金(23ZR1410100).Supported by Natural Science Foundation of Shanghai(23ZR1410100). （23ZR1410100）
