超声内镜检查术对食管-胃底静脉曲张患者食管静脉曲张套扎术治疗效果的评价

Evaluation of therapeutic effect of endoscopic ultrasonography on esophageal varices ligation in patients with esophago-gastric fundal varices

摘要:

目的 应用超声内镜检查术（EUS）对接受食管静脉曲张套扎术（EVL）的乙肝肝硬化伴食管-胃底静脉曲张（EGV）患者的治疗效果进行评价。方法 选取2019年6月－2021年12月该院接受EVL治疗，并定期来院进行胃镜或EUS复诊的乙肝肝硬化伴EGV患者64例（男42例，女22例），年龄54.0（41.0，70.0）岁。依据患者的EVL治疗效果，分为正常组（n = 25）和不良组（n = 39），对两组患者一般资料、实验室指标及EUS表现进行单因素和多因素分析。结果 正常组年龄为51.0（37.0，60.0）岁，小于不良组的60.0（43.0，72.0）岁，差异有统计学意义（P < 0.05）；不良组血红蛋白（Hb）为107.0（91.0，122.0）g/L，低于正常组的116.0（102.0，141.0）g/L，差异有统计学意义（P < 0.05）；不良组胃旁静脉、胃穿支静脉和食管穿支静脉发生率分别为56.4%（22例）、59.0%（23例）和64.1%（25例），与正常组的28.0%（7例）、20.0%（5例）和36.0%（9例）比较，差异均有统计学意义（P < 0.05）。将上述差异有统计学意义的因素纳入多因素分析，结果显示：年龄、胃旁静脉、胃穿支静脉及食管穿支静脉为影响接受EVL的乙肝肝硬化伴EGV患者治疗效果的独立危险因素。结论 胃旁静脉、胃穿支静脉和食管穿支静脉的存在，是接受EVL治疗的乙肝肝硬化伴EGV患者治疗效果不佳的EUS特征，早期鉴别有助于改善患者预后。

Abstract:

Objective Endoscopic ultrasonography (EUS) was used to evaluate the therapeutic effect of esophageal varices ligation (EVL) on patients with hepatitis B cirrhosis with esophago-gastric fundal varices (EGV).Methods From June 2019 to December 2021, 64 patients (42 males and 22 females, respectively) with hepatitis B cirrhosis with EGV who received EVL treatment and came to the hospital for gastroscopy or EUS follow-up visit, aged 54.0 (41.0, 70.0) years. According to the response of endoscopic treatment, the cases were divided into two groups: normal response group (n = 25) and adverse response group (n = 39). The general data, laboratory indicators and EUS performance of the two groups were analyzed by univariate and multivariate analysis.Results The age of the normal response group was 51.0 (37.0, 60.0) years, which was lower than that of the adverse response group 60.0 (43.0, 72.0) years, with statistical significance (P < 0.05). The hemoglobin (Hb) in the adverse response group was 107.0 (91.0, 122.0) g/L, which was lower than that in the normal response group 116.0 (102.0, 141.0) g/L, with statistical significance (P < 0.05). The incidence rates of gastric paragastric vein, gastric perforating branch vein and esophageal perforating branch vein in the adverse response group were 56.4% (22 cases), 59.0% (23 cases) and 64.1% (25 cases), respectively, compared with 28.0% (7 cases), 20.0% (5 cases) and 36.0% (9 cases) in the normal response group, with statistical significance (P < 0.05). The results showed that age, gastric paragastric vein, gastric perforating branch vein and esophageal perforating branch vein were independent risk factors affecting the treatment response of EGV patients with hepatitis B cirrhosis treated by EVL.Conclusion Gastric paragastric vein, gastric perforating branch vein and esophageal perforating branch vein are EUS features of adverse response of EGV patients with hepatitis B cirrhosis treated with EVL. Early screening of them will help to improve the overall prognosis of patients.