用食道支架治疗的耐火性水出血患者的生存率改善:一个多中心队列研究
Delphine Weil1,2, Morgane Clément1, Charlotte Bouzbib3
1Service d'Hépatologie et Soins Intensifs Digestifs, CHU Jean Minjoz, Besançon, France.
JHEP reports : innovation in hepatology
|December 1, 2025
概括
食道支架 (ESs) 显著改善出血控制和降低与气球吸管 (BT) 相比,耐火性水出血患者的死亡率. ESs提供了生存益处,使其成为首选的吸管装置.
科学领域:
- 胃肠病学 胃肠病学
- 肝病学 肝病学是一种肝病学.
- 干预性内镜检查是干预性的内镜检查.
背景情况:
- 在肝硬化中,耐火性水出血需要有效的坦波纳德治疗.
- 食道支架 (ESs) 和气球吸管 (BT) 是关键的管理选择.
- 关于ESs与BT对抗出血控制和生存的比较数据有限.
研究的目的:
- 为了比较食道支架 (ESs) 与气球吸管 (BT) 对耐火性水出血的疗效.
- 评估ES或BT治疗的患者的早期出血控制和6周死亡率.
- 评估治疗对肝硬化患者生存结果的影响.
主要方法:
- 一项多中心队列研究分析了63名肝硬化和耐火性水出血的患者.
- 患者接受了食道支架 (ESs) 或气球吸管 (BT).
- 倾向性得分分析 (IPTW) 和多变量模型 (Cox,物流回归) 用于调整MELD得分和救援TIPS等混因素.
主要成果:
- 食道支架 (ESs) 与6周死亡率 (36.7%与72.7%) 显著降低,与气球吸管 (BT) 相比,更好地控制了5天的出血.
- 经过调整后的分析证实,ESs降低了6周的死亡率 (HR=0.26) 并改善了5天的出血控制 (OR=6.1).
- 虽然ES的不良事件 (支架迁移) 较频繁,但BT与更严重的并发症 (如食道破裂) 有关.
结论:
- 消化管支架 (ESs) 在耐火性水出血中显示出优越的早期出血控制和较低的死亡率,相比于气球吸管 (BT).
- 对于这种患者群体来说,ESs 是一种最佳的吸管装置.
- 建议进行进一步的前性研究来验证这些发现.
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