本文選題：食管胃靜脈曲張出血 + 內(nèi)鏡治療　； 參考：《福建醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:比較內(nèi)鏡下治療與外科手術(shù)治療肝硬化食管胃靜脈曲張出血的療效。材料與方法:回顧性分析160例食管胃靜脈曲張出血的患者,根據(jù)治療方式不同分為兩組,其中行內(nèi)鏡下治療72例(內(nèi)鏡治療組),外科手術(shù)治療88例(外科手術(shù)組),比較兩組的急診止血成功率、早期再出血率、遲發(fā)性出血率、靜脈消失率、病死率及進(jìn)行生存函數(shù)分析,并探討內(nèi)鏡治療后早期再出血的可能相關(guān)危險(xiǎn)因素。結(jié)果:內(nèi)鏡治療組早期再出血率明顯高于外科手術(shù)組(37.5%vs7.95%,P=0.000),而其遲發(fā)性出血率遠(yuǎn)遠(yuǎn)低于外科手術(shù)組(5.88%vs 21.95%,P=0.000),靜脈消失率亦顯著高于外科手術(shù)組(70.83%vs 42.05%,p=0.001),差異均有統(tǒng)計(jì)學(xué)意義。Logistic回歸分析提示既往行手術(shù)治療史為內(nèi)鏡治療后早期再出血的保護(hù)因素,而曲張靜脈最大直徑為內(nèi)鏡治療后早期再出血的危險(xiǎn)因素。內(nèi)鏡治療組病死率較外科手術(shù)組高(16.66%vs 4.55%,P=0.028),而二者的遠(yuǎn)期生存率無(wú)明顯差異。內(nèi)鏡治療組與外科手術(shù)組在急診止血成功率上亦無(wú)明顯差異(98.61%vs 96.59%,p=0.628)。結(jié)論:對(duì)肝硬化食管胃靜脈曲張出血,內(nèi)鏡治療在近期療效上較外科手術(shù)略差,但內(nèi)鏡治療的靜脈消失率及遲發(fā)性出血率均優(yōu)于外科組,兩種治療方式在遠(yuǎn)期生存率上無(wú)差異。
[Abstract]:Objective: to compare the efficacy of endoscopic and surgical treatment for esophageal and gastric variceal hemorrhage due to cirrhosis. Materials and methods: 160 patients with esophageal and gastric variceal bleeding were retrospectively analyzed and divided into two groups according to different treatment methods. Among them, 72 cases were treated by endoscopy (endoscopic treatment group and 88 cases by surgical treatment). The success rate of emergency hemostasis, early rebleeding rate, delayed hemorrhage rate and venous disappearance rate were compared between the two groups. The mortality and survival function were analyzed and the risk factors of early rebleeding after endoscopic therapy were discussed. Results: the rate of early rebleeding in endoscopic group was significantly higher than that in surgical group (37.5vs 7.95), but the rate of delayed bleeding was much lower than that in surgical group (5.88 vs 21.95 P 0.000). The rate of venous disappearance was also significantly higher than that of surgical group (70.883 vs 42.05p0.001). Regression analysis showed that the history of previous surgical treatment was a protective factor for early rebleeding after endoscopic therapy. The maximum diameter of variceal vein was a risk factor for early rebleeding after endoscopic therapy. The mortality rate of endoscopic treatment group was higher than that of surgical operation group (16.66% vs 4.55%), but there was no significant difference in long-term survival rate between the two groups. There was no significant difference in the success rate of emergency hemostasis between the endoscopic treatment group and the surgical operation group (98.61 vs 96.59). Conclusion: in the treatment of esophageal and gastric variceal bleeding due to cirrhosis, the short-term curative effect of endoscopic treatment is slightly worse than that of surgical operation, but the rate of venous disappearance and delayed hemorrhage in endoscopic treatment is better than that in surgical group, and there is no difference in long-term survival rate between the two treatment methods.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R657.34

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本文編號(hào)：2003420