内镜治疗肝癌合并门静脉癌栓引起的食管胃底静脉曲张出血的疗效分析

Efficacy of endoscopic therapy in treatment of esophageal gastric varices bleeding in patients with hepatocellular carcinoma and portal vein tumor thrombus

摘要:

目的 明确内镜治疗肝癌合并门静脉癌栓患者发生食管胃底静脉曲张出血的止血效果与意义。 方法 回顾性分析2013 年1 月-2015 年12 月首都医科大学附属北京地坛医院住院收治食管胃底静脉曲张出 血的肝癌伴门静脉癌栓的患者，比较非内镜治疗组和内镜治疗组患者止血治疗效果、主要死亡原因及生存时 间。结果 共纳入76 例患者，非内镜治疗组27 例，内镜治疗组49 例。非内镜治疗组有40.7%（11/27）的患 者1 周内死亡，81.5%（22/27）死于食管胃底静脉曲张出血，平均生存期为（42.03±13.94）d ；内镜治疗组 仅16.3%（8/49）的患者 1 周内死亡（P <0.05），55.1%（27/49）死于食管胃底静脉曲张出血（P <0.05），平均 生存期为（174.24±34.42）d（P <0.05）。结论 内镜下治疗能有效地降低患者死于食管胃底静脉曲张出血的 风险，延长患者生存期，具有临床意义。

Abstract:

Objective To compare the effect and survival period of endoscopic treatment group and non endoscopic treatment group of esophageal gastric varices bleeding in patients with hepatocellular carcinoma and portal vein tumor thrombus, in order to define the significance of endoscopic therapy for prolonging the survival period of patients. Methods 76 patients diagnosed as esophageal gastric varices bleeding with hepatocellular carcinoma and portal vein tumor thrombus from Jan. 2013 to Dec. 2015 were enrolled, of all these cases, 27 were non endoscopic treatment group and 49 were endoscopic treatment group. The medical records were analyzed retrospectively. Then compare the effect of emergency treatment, the main causes of death and survival time of the two groups. Results In the non endoscopic treatment group, 40.7% (11/27) patients died in one week after bleeding, 81.5% (22/27) patients died of esophageal gastric varices bleeding, the mean survival period was (42.03 ± 13.94) days; In the endoscopic treatment group, only 16.3% (8/49) patients died in one week (P < 0.05), 55.1% (27/49) patients died of esophageal gastric varices bleeding (P < 0.05), the mean survival time was (174.24 ± 34.42) days (P < 0.05). Conclusions Endoscopic therapy can effectively reduce the risk of death from acute hemorrhage and prolong the survival time in patients with hepatocellular carcinoma and portal vein tumor thrombus.