肝硬化患者食管胃静脉曲张出血内镜治疗前后出血以外并发症及危险因素分析

IF 2.7 4区 医学 Q2 Medicine Canadian Journal of Gastroenterology and Hepatology Pub Date : 2023-01-01 DOI:10.1155/2023/7556408
Xiaowei Duan, Xing He, Hezhong Yan, Haiqing Li, Jiaoxue Wang, Shicun Guo, Zhengwei Zha, Qianqian Zhang, Yuchuan Bai, Jiayi Zhang, Jun Tang, Derun Kong
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引用次数: 0

摘要

目的:探讨肝硬化患者食管胃静脉曲张出血(EGVB)内镜治疗前后除出血(COTB)外的其他并发症,并探讨其潜在的危险因素。材料与方法:选取2017年11月至2020年8月在我院行介入内镜治疗的肝硬化合并EGVB患者为研究对象。回顾性分析入院时和首次内镜治疗后2年内的临床资料。在治疗前后对患者进行COTB潜在危险因素筛查。采用单因素分析确定继发性并发症的临床因素,多因素Cox和logistic回归分析纳入有统计学意义的因素。结果:547例肝硬化患者中,361例首次内镜治疗时发生COTB。在这个队列中,发病率最高的前3位是门静脉血栓形成(PVT)或海绵状症、胆石症和致病性感染。171例肝硬化患者入院时未发生COTB,但在随访时发生。较高的Child-Pugh评分表明存在多种并发并发症的潜在风险,包括出血。内镜下EGVB治疗后并发PVT或海绵样改变、致病性感染、胆石症等危险因素可延长肝硬化症状,而在EGV程度较高、血清D-D水平较高、血钙水平较低的情况下,非胆汁淤积型肝硬化患者的风险可能低于乙型肝炎后肝硬化患者。结论:临床治疗和干预可以有针对性地避免EGVB治疗期间和治疗后的其他并发症,这些并发症会影响出血症状的结局和预后。
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Analysis of Complications and Risk Factors Other than Bleeding before and after Endoscopic Treatment of Esophagogastric Variceal Bleeding in Patients with Liver Cirrhosis.

Objective: To identify any concomitant complications other than bleeding (COTB) before and after endoscopic treatment of esophagogastric variceal bleeding (EGVB) in liver cirrhosis patients and explore the underlying risk factors.

Materials and methods: Cirrhotic patients complicated with EGVB, who underwent interventional endoscopic treatments in our hospital from November 2017 to August 2020, were enrolled in this study. Clinical data were retrospectively analyzed for COTB at admission and within 2 years of the first endoscopic treatment. Patients were screened for potential risk factors of COTB before and after the treatment. Univariate analysis was performed to identify clinical factors of secondary complications, and statistically significant factors were included in the multivariate Cox and logistic regression analyses.

Results: Of the 547 patients with cirrhosis, 361 individuals had COTB in the first endoscopic treatment. In this cohort, the top 3 prevalent incidences were portal vein thrombosis (PVT) or spongiosis, cholelithiasis, and pathogenic infections. The COTB did not occur at admission in 171 liver cirrhosis patients but happened at the follow-up. Higher Child-Pugh scores indicated potential risks of multiple concurrent complications, including bleeding. Risk factors for concomitant PVT or cavernous changes after endoscopic treatment of EGVB, pathogenic infections, and cholelithiasis could prolong the cirrhosis symptoms, while noncholestatic cirrhosis patients might have a lower risk than posthepatitis B cirrhosis patients, in the context of a higher degree of EGV and serum level of D-D and a lower blood calcium level.

Conclusions: Clinical treatment and interventions can be tailored to avoid other complications during and after EGVB treatment, which can affect the outcome and prognosis of bleeding symptoms.

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来源期刊
CiteScore
4.80
自引率
0.00%
发文量
0
审稿时长
37 weeks
期刊介绍: Canadian Journal of Gastroenterology and Hepatology is a peer-reviewed, open access journal that publishes original research articles, review articles, and clinical studies in all areas of gastroenterology and liver disease - medicine and surgery. The Canadian Journal of Gastroenterology and Hepatology is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
期刊最新文献
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