發(fā)布時(shí)間：2018-05-17 23:29

  本文選題：食管靜脈曲張 + 內(nèi)鏡治療�。� 參考：《山東大學(xué)》2014年碩士論文

【摘要】：目的： 通過對(duì)比食管靜脈曲張患者臨床特征和內(nèi)鏡治療后早期再出血的發(fā)生,尋找和證實(shí)影響內(nèi)鏡治療后早期再出血的主要危險(xiǎn)因素,并探討這些危險(xiǎn)因素的臨床應(yīng)用意義以及對(duì)早期再出血預(yù)測診斷價(jià)值。 方法： 收集2011.08.01-2013.10.31期間,在山東大學(xué)附屬省立醫(yī)院消化內(nèi)科住院并行食管靜脈曲張內(nèi)鏡治療的患者。常規(guī)記錄患者的一般信息、肝功能評(píng)估、內(nèi)鏡治療方案、食管曲張靜脈相關(guān)特征以及血清學(xué)和影像學(xué)相關(guān)結(jié)果(包括：Child-pugh分級(jí)、轉(zhuǎn)氨酶、血細(xì)胞、尿素氮、膽紅素、凝血功能、靜脈曲張程度、門靜脈內(nèi)徑等)。對(duì)上述58例患者內(nèi)鏡治療后早期再出血的相關(guān)情況進(jìn)行隨訪,記錄是否早期再出血及出血的時(shí)間等相關(guān)事項(xiàng)。采用卡方檢驗(yàn)分析患者相關(guān)臨床特征與早期再出血的關(guān)系；Kaplan-Meier單因素生存分析尋找對(duì)早期再出血有影響的臨床特征,并建立Cox風(fēng)險(xiǎn)回歸模型,進(jìn)一步確定影響早期再出血的獨(dú)立危險(xiǎn)因素；同時(shí),使用受試者工作曲線(ROC)分析評(píng)估這些獨(dú)立危險(xiǎn)因素的臨床預(yù)測價(jià)值。 結(jié)果： 1、共入組患者58例,其中男性42例,女性16例,平均年齡54.3±12.1歲,其中行EVL治療的患者共21例(36%),EIS治療的共30例(52%),EVL+EIS聯(lián)合治療的共7例(12%)。術(shù)后隨訪期間,共有11例患者出現(xiàn)早期再出血,其中EVL治療組6例,EIS治療組3例,EVL+EIS聯(lián)合治療組1例,出血導(dǎo)致死亡2例。 2、且兩組在肝功能Child-pugh分級(jí)(P=0.008)、門靜脈栓子形成(P=0.005)、靜脈曲張程度(P=0.043)、術(shù)前腹水程度(P=0.005)4方面有顯著性差異(p0.05)。在白細(xì)胞(WBC)血紅蛋白(HB)、血小板(PLT)、門冬氨酸基轉(zhuǎn)移酶(AST)丙氨酸基轉(zhuǎn)移酶(ALT)、白蛋白(ALB)、總膽紅素(TBIL)、凝血酶原時(shí)間(PT)、纖維蛋白原(Fig)、尿素氮(BUN)不是早期再出血的危險(xiǎn)因素。(p0.05) 3、在所研究的患者相關(guān)臨床特征中,術(shù)前靜脈曲張程度(P=0.034)、術(shù)前腹水程度、(P=0.007)、術(shù)前肝功能Child-pugh分級(jí)(P0.0001)、血清尿素氮水平(P=0.017)、血清白蛋白水平(P=0.026)、術(shù)前曲張靜脈紅色征(P=0.001)均能顯著影響患者的累計(jì)無早期出血率。在所建立的Cox風(fēng)險(xiǎn)回歸模型中,血清尿素氮水平(危險(xiǎn)系數(shù)[HR]=1.346,P=0.015)和術(shù)前腹水程度(HR=3.185,P=0.029)這兩個(gè)因素成為內(nèi)鏡治療后早期再出血的獨(dú)立危險(xiǎn)因素。 4、ROC曲線評(píng)估這些獨(dú)立危險(xiǎn)因素對(duì)早期再出血的臨床預(yù)測價(jià)值,血清尿素氮水平和術(shù)前腹水程度的曲線下面積(AUC)分別為0.683(P=0.071)和0.801(P=0.003),其中術(shù)前腹水程度的診斷效率優(yōu)于其他臨床特征。 結(jié)論： 1、術(shù)前Child-pugh分級(jí)、術(shù)前曲張靜脈程度、術(shù)前腹水程度、血清尿素氮水平、血清白蛋白水平、術(shù)前曲張靜脈紅色征均是影響曲張靜脈內(nèi)鏡治療后早期再出血的因素：其中尿素氮水平和術(shù)前腹水情況是獨(dú)立危險(xiǎn)因素。 2、術(shù)前患者腹水情況能夠有效判斷靜脈曲張內(nèi)鏡治療后患者早期再出血的預(yù)
[Abstract]:Objective: By comparing the clinical features of patients with esophageal varices and the occurrence of early rebleeding after endoscopic therapy, the main risk factors affecting early rebleeding after endoscopic therapy were found and confirmed. To explore the clinical application significance of these risk factors and its diagnostic value in early re-bleeding. Methods: Patients with esophageal varices treated by endoscopy in the Department of Digestive Medicine, affiliated Hospital of Shandong University, were collected during the period of October 31, 2011.08.01-2013.10.31. Routine recording of patients' general information, liver function assessment, endoscopic therapy, esophageal varices associated features, and serological and image-related results (including: Child-pugh classification, transaminase, blood cells, urea nitrogen, bilirubin, coagulation function, Degree of varicose vein, diameter of portal vein, etc. 58 patients were followed up to record whether early rebleeding and the time of bleeding. Using chi-square test to analyze the relationship between clinical characteristics and early rebleeding. Kaplan-Meier single factor survival analysis was used to search for the clinical characteristics that had an effect on early rebleeding, and Cox risk regression model was established. The clinical predictive value of these independent risk factors was evaluated by means of ROC-based analysis. Results: 1. There were 58 patients in the group, including 42 males and 16 females with an average age of 54.3 鹵12.1 years. Among them, 21 cases were treated with EVL, 30 cases were treated with EIS, and 7 cases were treated with EVL EIS. During the follow-up period, there were 11 cases of early rebleeding, including 6 cases of EVL treatment group, 3 cases of EVL EIS combined treatment group (1 case), and 2 cases of death caused by hemorrhage. 2. There were significant differences between the two groups in Child-pugh grade of liver function (P < 0.008), portal vein embolus formation (P < 0.005), varicose degree (P < 0.043) and ascites (P < 0.05) before operation. Alanine transaminase (alt), Albumin (ALBN), total bilirubin (TBILL), prothrombin time (PTT), fibrinogen (Fign), urea nitrogen (bun) are not risk factors for early rebleeding. 3. Among the clinical characteristics of the patients studied, Preoperative varicose degree, preoperative ascites degree, preoperative Child-pugh grade, serum urea nitrogen level, serum albumin level, preoperative varicose vein red sign and preoperative varicose vein red sign P0. 001 can significantly affect the accumulative rate of no early bleeding. In the established Cox risk regression model, serum urea nitrogen level (risk coefficient [HR] 1.344 P0. 015) and preoperative ascites level (HR3. 185 P0. 029) were independent risk factors for early rebleeding after endoscopic therapy. The ROC curve was used to evaluate the clinical predictive value of these independent risk factors for early rebleeding. The area under the curve of serum urea nitrogen level and preoperative ascites degree were 0.683 and 0.801mP0. 003, respectively. The diagnostic efficiency of preoperative ascites was better than that of other clinical features. Conclusion: 1. Preoperative Child-pugh grade, preoperative varicose vein degree, preoperative ascites degree, serum urea nitrogen level, serum albumin level, The red sign of varicose vein before operation is the factor that affects the early rebleeding after variceal endoscopy. The level of urea nitrogen and ascites before operation are independent risk factors. 2. Preoperative ascites can be used to evaluate the early rebleeding of patients with varicose varices after endoscopic therapy.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R571

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 Natalie Funakoshi;Frédérique Ségalas-Largey;Yohan Duny;Frédéric Oberti;Jean-Christophe Valats;Michael Bismuth;Jean-Pierre Daurès;Pierre Blanc;;Benefit of combination β-blocker and endoscopic treatment to prevent variceal rebleeding: A meta-analysis[J];World Journal of Gastroenterology;2010年47期

2 ;Risk factors for predicting early variceal rebleeding after endoscopic variceal ligation[J];World Journal of Gastroenterology;2011年28期

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本文編號(hào)：1903358