ปัจจัยที่เกี่ยวข้องในการเกิดเลือดออกซ้ำในผู้ป่วยโรคตับแข็งภายในเวลา 6 เดือน ภายหลังการรักษาหลอดเลือดขอดที่หลอดอาหารโดยวิธีรัดหลอดเลือดครั้งแรก / บุบผา พรธิสาร = Factors related to rebleeding in cirrhotic patients within 6 months after the first session of endoscopic variceal ligation / Bubpha Pornthisarn
Objectives : To determine factors related to rebleeding in cirrhotic patients within 6 months after the first session of endoscopic variceal ligation (EVL). Patients and Method : One-hundred-and-fifteen patients were enrolled between January 1993 to June 2000. There were 90 males and 25 females. EVL was performed every 2-3 week up to variceal obliteration. Followed up was made every 1-3 month thereafter. Clinical parameters, biochemical parameters and endoscopic findings, including numbers of rubber bands were recorded. Patients were followed up at least once in the six-month period following the first session of EVL. The study end points were 6 months after the first EVL or the occurrence of rebleeding within 6 months. Result : There were 115 cirrhotic patients undergoing EVL treatment. The mean age was 50.9 ± 12.1 years (range 24-85 years). Hepatocellular carcinoma was presented in 13 cases (11.3%). Sixty percent of patients had no underlying disease. At the 6-month end-point, 44 (38.3%) patients had rebleeding. Twenty-five patients (57%) rebleed from esophageal variceal rupture. Rebleeding was from gastric varices 2 cases (4.5%), from esophageal ulcer in 2 cases (4.5%), and from otherss causes in 4 cases (9.6%). The causes of rebleeding in 11 cases were undetermined, as gastroscopy could not be performed from poor patient conditions. The factors that showed significant difference between the variceal rebleeding group and the non-bleeding group were serum total bilirubin (7.78 ± 12.7 vs 2.75 ± 3.07 p=0.03), Child Pugh score (9.22 ± 2.54 vs 7.95 ± 2.31 p=0.045), obliteration rate (20% vs 71.8% p=0.00), presence of gastric varices (28.0% vs 7.04% p=0.012) and presence of hepatocellular carcinoma (24% vs 4.2% p=0.04). Multiple logistic regression analysis revealed 2 factors related to rebleeding after EVL 1 i.e. presence of hepatocellular carcinoma (OR = 13.24, 95% Cl 1.932 ± 90.838 p= 0.0085) and successful variceal obliteration (OR = 0.062, 95% Cl 0.0163 ± 0.2385 p=0.0001) Conclusion : These data suggest that factors related to rebleeding within 6 months after EVL were no obliteration of varices, presence of gastric varices and presence of hepatoma.