Survival analysis for primary hepatocellular carcinoma patients with esophageal varices rupture hemorrhage who underwent endoscopic variceal ligation in different Child-Pugh level
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摘要:
目的 分析不同Child-Pugh分级的原发性肝癌并发食管静脉曲张破裂出血并接受套扎术后患者的预后与生存情况。 方法 入选患者74例作为观察组，以未接受套扎的53例作为对照组，比较两组的预后与生存时间。 结果 随访期内对照组的再出血高于观察组（54.7% vs 17.6%，P=0.000），且再出血量大于观察组（P<0.05）。观察组的生存期均数及中位数分别为31及32月，而对照组分别为21及16月，Kaplan-Meier分析显示两组患者的生存期差异具有统计学意义（χ2=9.499，P=0.002）。接受内镜下静脉曲张套扎术治疗的Child-Pugh A级B级患者的再出血时间间隔延长、再出血率降低、再出血量减少、患者的生存期延长，但对Child-Pugh C级患者的疗效尚有待更多病例验证。 结论 食管静脉曲张破裂出血肝功能为Child-Pugh A、B级患者应尽早行内镜下静脉曲张套扎术，Child-Pugh C级患者采用内镜下静脉曲张套扎术的并不会缩短患者的生存时间。 Abstract:Objective To explore prognosis and survival situation of patients underwent endoscopic variceal ligation for primary liver cancer complicated with esophageal varices rupture hemorrhage. Methods Seventy-four patients were included as the observation group. Fifty-three patients who did not underwent endoscopic variceal ligation were chosed as control group. Prognosis and living time between 2 groups were compared. Results During the follow-up period, hemorrhage cases in observation group was significantly higher than that of control group (54.7% vs 17.6%, P=0.000). The volume of bleeding in control group was significantly greater than that of observation group. The arithmetic mean and median of the living time in observation group were 31 and 32 months, respectively.While the control group were 21 and 16 months. Kaplan Meier-analysis showed that the difference of living time in two groups was significant (χ2=9.499, P=0.002). Patients who underwent endoscopic variceal ligation in Child-Pugh A and B level had a long interval time to rebleeding, reduced rebleeding rate and volume, and a long living time. But for the patients in Child-Pugh C level, the effect of endoscopic variceal ligation needed more evidence. Conclusion Patients with esophageal varices rupture hemorrhage in Child-Pugh A and B level should underwent endoscopic variceal ligation as early as possible. Survival time of patients in Child-Pugh C level underwent endoscopic variceal ligation will not be shortened. -
表 1 两组患者一般情况与出血情况比较（n，Mean±SD）
分组 观察组（n=74） 对照组（n=53） χ2/t P 性别 男 53 42 χ2=0.95 0.329 女 21 11 年龄（岁） 59.23±5.99 58.49±5.78 t=0.70 0.488 首次出血量（mL） 585.14±191.56 539.62±141.20 t=1.54 0.126 再次出血间隔（月） Child-Pugh A 35.25±9.43 16.00±5.01 t=5.58 0.000 Child-Pugh B 25.50±8.51 14.63±7.27 t=2.32 0.043 Child-Pugh C 15.00±6.52 10.71±2.87 t=1.56 0.149 再次出血量（mL） Child-Pugh A 450.00±195.79 753.57±183.41 t=–2.88 0.011 Child-Pugh B 46.50±110.87 793.75±238.20 t=–2.60 0.027 Child-Pugh C 700.00±329.77 1028.57±273.64 t=–1.89 0.088 
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表 2 两组患者的生存期记录分析列表
生存期（月） 观察组 对照组 χ2 p ≤15 14 24 17.61 0.001 16~30 22 20 31~45 19 3 ≥46 10 2 删失 9 6 最长生存期 64+ 58+
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表 3 不同Child-Pugh分级患者生存时间的比较
Child-Pugh分级 观察组 对照组 χ2 P A级 40.31/39 25.38/24 8.228 0.004 B级 27.02/24 16.50/14 4.720 0.030 C级 17.33/13 11.71/13 1.649 0.199
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