肝硬化食管胃底靜脈曲張合并脾大或脾亢的治療方法研究
發(fā)布時(shí)間：2018-09-11 05:47
【摘要】：目的:探究?jī)?nèi)鏡下治療及內(nèi)鏡下治療聯(lián)合脾動(dòng)脈部分栓塞兩種治療方法對(duì)肝硬化食管胃底靜脈曲張破裂并發(fā)脾大或脾亢患者預(yù)后的影響。方法:本研究納入肝硬化食管胃底靜脈曲張破裂合并脾大或脾亢的患者29人,內(nèi)鏡治療組(A組)患者14例,男性8例,女性6例,年齡31-75歲,平均年齡54.57±14.70歲。聯(lián)合治療組(B組)共15例患者,男性11例,女性4例,年齡40-71歲,平均年齡53.13±9.46歲。A組行內(nèi)鏡下食管曲張靜脈套扎及胃底曲張靜脈硬化治療,初次內(nèi)鏡下治療后2-4周行第2次治療,直至曲張靜脈消失或者患者不再進(jìn)行治療為止。B組患者行脾動(dòng)脈部分栓塞治療(與內(nèi)鏡下治療間隔1-4周)及內(nèi)鏡下治療(治療方案同A組)。所有治療結(jié)束后6個(gè)月或再次出血作為兩組的觀察終點(diǎn)。分別在術(shù)前、術(shù)后1及6個(gè)月檢查患者的肝功、凝血系列、腎功、血常規(guī)、腹部B超或CT,評(píng)估Karnofsky行為狀態(tài)(KPS)評(píng)分及肝臟Child-Pugh分級(jí)。比較兩組術(shù)后1及6個(gè)月與術(shù)前的臨床癥狀、體征、谷草轉(zhuǎn)氨酶、谷丙轉(zhuǎn)氨酶、總膽紅素、白蛋白、凝血酶原時(shí)間、凝血酶原活動(dòng)度、肌酐、白細(xì)胞、血小板、血紅蛋白、KPS評(píng)分及肝臟Child-Pugh分級(jí)的變化,評(píng)估A、B兩組的臨床療效,分析再出血的發(fā)生與可能危險(xiǎn)因素的關(guān)系。結(jié)果:隨訪期間,A組1例酒精性肝硬化患者及1例病因不明肝硬化患者分別在術(shù)后第3和第6個(gè)月再次出血。B組1例乙型病毒性肝炎肝硬化患者及1例酒精性肝硬化患者分別在術(shù)后第2和第5個(gè)月再次嘔血。A組套扎次數(shù)顯著大于B組(P0.05)且兩組患者再出血率無明顯差異(兩組中堅(jiān)持治療至曲張靜脈消失者僅各有1例)。A組術(shù)后1月14例患者白蛋白改善顯著(P0.05),谷草轉(zhuǎn)氨酶、谷丙轉(zhuǎn)氨酶、總膽紅素、凝血酶原時(shí)間、凝血酶原活動(dòng)度、肌酐、血紅蛋白、血小板及白細(xì)胞水平與術(shù)前相比有所改善,但差異無顯著性(P0.05)。13例患者術(shù)后6月的白蛋白及血紅蛋白與術(shù)前相比有顯著改善(P0.05),而其他以上提及的血液指標(biāo)均無明顯改善(P0.05)。術(shù)后1個(gè)月,14例患者中Child-Pugh A級(jí)百分比由71.43%增加到78.57%,Child-Pugh B級(jí)百分比維持于21.43%,1例Child-PughC級(jí)改善為B級(jí)�；颊逰PS改善不明顯(P0.05)。術(shù)后6個(gè)月,Child-PughA級(jí)和Child-Pugh B級(jí)百分比分別為84.62%和15.38%�；颊逰PS改善顯著(P0.05)。B組15例患者術(shù)后1個(gè)月的白蛋白、凝血酶原時(shí)間、血紅蛋白、血小板及白細(xì)胞與術(shù)前相比明顯改善(P0.05),谷草轉(zhuǎn)氨酶、谷丙轉(zhuǎn)氨酶、凝血酶原活動(dòng)度、總膽紅素和肌酐較術(shù)前并無顯著差異(P0.05)。術(shù)后6個(gè)月13例患者的白蛋白、凝血酶原時(shí)間、凝血酶原活動(dòng)度和血紅蛋白、血小板及白細(xì)胞與術(shù)前相比改善明顯(P0.05)。谷草轉(zhuǎn)氨酶、谷丙轉(zhuǎn)氨酶、總膽紅素和肌酐與術(shù)前相比差異均不顯著(P0.05)。術(shù)后1月15例患者中Child-Pugh A級(jí)百分比由60%增加到86.67%,Child-Pugh B級(jí)患者百分比由40%減少為13.33%。術(shù)后6個(gè)月13例患者的Child-Pugh分級(jí)均改善為A級(jí)。術(shù)后1月及6月時(shí),患者KPS與治療前相比均有顯著改善(P0.05)。再出血的發(fā)生與術(shù)前食管靜脈曲張的直徑呈正相關(guān)關(guān)系。結(jié)論:脾動(dòng)脈部分栓塞聯(lián)合內(nèi)鏡下操作治療肝硬化食管胃底靜脈曲張破裂并發(fā)脾大或脾功能亢進(jìn)安全、有效、可行,近期內(nèi)可明顯改善肝臟Child-Pugh分級(jí)和KPS評(píng)分。相比于內(nèi)鏡下治療,聯(lián)合治療可明顯改善患者的白細(xì)胞、血小板的水平及減少套扎次數(shù)。
[Abstract]:Objective: To investigate the effect of endoscopic treatment and endoscopic treatment combined with partial splenic artery embolization on the prognosis of patients with cirrhosis complicated by esophagogastric varices and splenomegaly or hypersplenism. There were 14 patients, 8 males and 6 females, aged 31-75 years, with an average age of 54.57 (+ 14.70). In the combined treatment group (group B), there were 15 patients, 11 males and 4 females, aged 40-71 years, with an average age of 53.13 (+ 9.46). In group A, the esophageal varices were ligated under endoscope and the gastric varices were sclerosed 2-4 weeks after the initial endoscopic treatment. Patients in group B received partial splenic artery embolization (1-4 weeks interval from endoscopic treatment) and endoscopic treatment (same treatment as group A). All patients were followed up for 6 months or bleeding again. Liver function and coagulation were examined before operation, 1 and 6 months after operation, respectively. Blood series, renal function, blood routine, abdominal ultrasonography or CT, Karnofsky behavior status (KPS) score and liver Child-Pugh grade were evaluated. The clinical symptoms, signs, glutamic oxaloacetic aminotransferase, alanine aminotransferase, total bilirubin, albumin, prothrombin time, prothrombin activity, creatinine, white blood cells, platelets, hemoglobin were compared between the two groups at 1 and 6 months after operation. Results: During the follow-up period, one alcoholic cirrhosis patient in group A and one unknown cirrhosis patient in group B had hemorrhage again at the 3rd and 6th month after operation. Patients with cirrhosis and 1 patient with alcoholic cirrhosis had hematemesis again at the 2nd and 5th month after operation. The number of ligations in group A was significantly higher than that in group B (P Enzyme, alanine aminotransferase, total bilirubin, prothrombin time, prothrombin activity, creatinine, hemoglobin, platelet and leukocyte levels were improved, but there was no significant difference (P 0.05). One month after operation, the percentage of Child-Pugh A increased from 71.43% to 78.57%, the percentage of Child-Pugh B remained at 21.43%, and that of Child-Pugh C was improved to B. The improvement of KPS was not significant in one patient (P 0.05). Six months after operation, the percentage of Child-Pugh A and Child-Pugh B were 84.62% and 15.38%, respectively. There was no significant difference in serum albumin, prothrombin time, hemoglobin, platelet and leukocyte (P 0.05), glutamic oxaloacetic aminotransferase, alanine aminotransferase, prothrombin activity, total bilirubin and creatinine (P 0.05) in group B at 1 month after operation. Prothrombin time, prothrombin activity and hemoglobin, platelets and white blood cells improved significantly (P 0.05). There were no significant differences in glutamic oxaloacetic aminotransferase, alanine aminotransferase, total bilirubin and creatinine between the two groups (P 0.05). The percentage of Child-Pugh A increased from 60% to 86.67% in 15 patients on January after surgery, and 100 in Child-Pugh B group. The Child-Pugh classification of 13 patients was improved to A grade at 6 months after operation. KPS was significantly improved at 1 month and 6 months after operation (P 0.05). There was a positive correlation between the occurrence of rebleeding and the diameter of esophageal varices before operation. Esophageal and gastric varices rupture with splenomegaly or hypersplenism is safe, effective and feasible, and can significantly improve the Child-Pugh classification and KPS score in the near future.
【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】：2017
【分類號(hào)】：R575.2
[Abstract]:Objective: To investigate the effect of endoscopic treatment and endoscopic treatment combined with partial splenic artery embolization on the prognosis of patients with cirrhosis complicated by esophagogastric varices and splenomegaly or hypersplenism. There were 14 patients, 8 males and 6 females, aged 31-75 years, with an average age of 54.57 (+ 14.70). In the combined treatment group (group B), there were 15 patients, 11 males and 4 females, aged 40-71 years, with an average age of 53.13 (+ 9.46). In group A, the esophageal varices were ligated under endoscope and the gastric varices were sclerosed 2-4 weeks after the initial endoscopic treatment. Patients in group B received partial splenic artery embolization (1-4 weeks interval from endoscopic treatment) and endoscopic treatment (same treatment as group A). All patients were followed up for 6 months or bleeding again. Liver function and coagulation were examined before operation, 1 and 6 months after operation, respectively. Blood series, renal function, blood routine, abdominal ultrasonography or CT, Karnofsky behavior status (KPS) score and liver Child-Pugh grade were evaluated. The clinical symptoms, signs, glutamic oxaloacetic aminotransferase, alanine aminotransferase, total bilirubin, albumin, prothrombin time, prothrombin activity, creatinine, white blood cells, platelets, hemoglobin were compared between the two groups at 1 and 6 months after operation. Results: During the follow-up period, one alcoholic cirrhosis patient in group A and one unknown cirrhosis patient in group B had hemorrhage again at the 3rd and 6th month after operation. Patients with cirrhosis and 1 patient with alcoholic cirrhosis had hematemesis again at the 2nd and 5th month after operation. The number of ligations in group A was significantly higher than that in group B (P Enzyme, alanine aminotransferase, total bilirubin, prothrombin time, prothrombin activity, creatinine, hemoglobin, platelet and leukocyte levels were improved, but there was no significant difference (P 0.05). One month after operation, the percentage of Child-Pugh A increased from 71.43% to 78.57%, the percentage of Child-Pugh B remained at 21.43%, and that of Child-Pugh C was improved to B. The improvement of KPS was not significant in one patient (P 0.05). Six months after operation, the percentage of Child-Pugh A and Child-Pugh B were 84.62% and 15.38%, respectively. There was no significant difference in serum albumin, prothrombin time, hemoglobin, platelet and leukocyte (P 0.05), glutamic oxaloacetic aminotransferase, alanine aminotransferase, prothrombin activity, total bilirubin and creatinine (P 0.05) in group B at 1 month after operation. Prothrombin time, prothrombin activity and hemoglobin, platelets and white blood cells improved significantly (P 0.05). There were no significant differences in glutamic oxaloacetic aminotransferase, alanine aminotransferase, total bilirubin and creatinine between the two groups (P 0.05). The percentage of Child-Pugh A increased from 60% to 86.67% in 15 patients on January after surgery, and 100 in Child-Pugh B group. The Child-Pugh classification of 13 patients was improved to A grade at 6 months after operation. KPS was significantly improved at 1 month and 6 months after operation (P 0.05). There was a positive correlation between the occurrence of rebleeding and the diameter of esophageal varices before operation. Esophageal and gastric varices rupture with splenomegaly or hypersplenism is safe, effective and feasible, and can significantly improve the Child-Pugh classification and KPS score in the near future.
【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】：2017
【分類號(hào)】：R575.2
【相似文獻(xiàn)】
相關(guān)期刊論文 前10條
1 密禮,李尊民,吳清海,蔡世峰,王桂霞;部分性脾栓治療脾亢34例報(bào)告[J];山東醫(yī)藥;2000年16期
2 張煜,李宗芳,孫曉力,王繼欣,蘇清華,劉效恭;門靜脈高壓癥脾功能亢進(jìn)脾巨噬細(xì)胞吞噬功能的變化及其與脾亢程度的相關(guān)性[J];中華普通外科雜志;2005年02期
3 劉順華;丁坤;;妊娠合并脾亢一例臨床分析[J];中外醫(yī)療;2012年26期
4 王崇恒,涂雁青;脾亢誤診為血小板減少性紫癜1例教訓(xùn)[J];西藏醫(yī)藥雜志;1998年02期
5 姚關(guān)兵;周軍;陳念平;陳明;;原發(fā)性肝癌合并門靜脈高壓、脾亢的外科治療[J];醫(yī)學(xué)綜述;2009年10期
6 楊志剛;梅志偉;常鋼;;改良的部分性脾動(dòng)脈栓塞術(shù)治療脾亢46例[J];中國(guó)中醫(yī)藥現(xiàn)代遠(yuǎn)程教育;2009年08期
7 王麗娜;何津祥;靳p，
本文編號(hào)：2235714
本文鏈接：http://sikaile.net/yixuelunwen/xiaohjib/2235714.html
最近更新
教材專著
