内镜下治疗食管胃底静脉曲张发生短期再出血危险因素分析

Risk Factors of Short-Term Rebleeding after Endoscopic Treatment of Esophageal and Gastric Varices

摘要: 目的：探讨分析内镜下治疗食管胃底静脉曲张发生短期再出血危险因素。方法：回顾性分析2019年5月至2024年10月西宁市第二人民医院消化内科收治的行手术治疗的肝硬化伴食管胃底静脉曲张患者临床资料，将患者分为出血和未出血两组，对两组患者的再出血率进行分析，并应用Logistic回归比例风险模型进行临床预后的多因素分析。结果：共纳人94例患者，其中男性58例，女性36例，平均年龄52.03 ± 10.89岁，再出血患者16例，治疗好转78人，其中性别、年龄，病程，PT，TP，WBC，RBC，PLT，Hb，门静脉内直径等因素无关，差异无统计学意义(P > 0.05)，白蛋白(OR = 0.845, 95% CI: 0.729~0.980)、静脉曲张程度(OR = 2.787, 95% CI: 1.031~7.530)、手术方式(OR = 19.090, 95% CI: 2.728~133.582)可以作为影响术后再出血独立危险因素，结论：内镜下食管胃曲张静脉断流术(ESVD)、静脉曲张严重程度和白蛋白水平对术后再出血发生率影响明显，术前合理的选择手术方式，纠正白蛋白水平可以改善患者预后，降低再出血发生率。

Abstract: Objective: To explore and analyze the risk factors of short-term rebleeding after endoscopic treatment of esophageal and gastric varices. Methods: the clinical data of cirrhotic patients with esophageal and gastric varices who underwent surgery in the Department of Gastroenterology of Xining Second People’s Hospital from April 2018 to December 2024 were retrospectively analyzed. The patients were divided into bleeding and non bleeding groups. The rebleeding rate of the two groups was analyzed, and the logistic regression proportional hazards model was applied to analyze the multivariate analysis of clinical prognosis. Results: a total of 94 patients were enrolled, including 58 males and 36 females, with an average age of 52.03 ± 10.89 years. There were 16 patients with rebleeding, and 78 patients improved after treatment, including gender, age, course of disease, PT, TP, WBC, RBC, PLT, Hb, there was no significant difference in the internal diameter of portal vein and other factors (P > 0.05). Albumin (or = 0.845, 95% CI: 0.729~0.980), the degree of varicose vein (or = 2.787, 95% CI: 1.031~7.530), and surgical method (or = 19.090, 95% CI: 2.728~133.582) can be used as independent risk factors for postoperative rebleeding. Conclusion: ESVD of esophageal vein, the severity of varices and albumin level have a significant impact on the incidence of postoperative rebleeding. Reasonable preoperative choice of surgical method and correction of albumin level can improve the prognosis of patients and reduce the incidence of rebleeding rate.