目的 探讨影响肝硬化食管胃底静脉曲张破裂出血（EGVB）内镜治疗后5年再发消化道出血的因素。 方法 回顾性选取2017年2月至2019年5月于中国科学技术大学附属第一医院就诊的肝硬化EGVB行内镜治疗的181例患者，至少随访5年。分析患者性别、年龄、肝硬化病因（病毒、酒精、自免、其他）、是否合并腹水、肝性脑病（无、1 ~ 2期、3期）、门静脉血栓、肝癌、门脉高压性胃病等并发症、外周血指标［谷草转氨酶（AST）、谷丙转氨酶（ALT）、白细胞（WBC）、总胆红素（TBIL）、白蛋白（ALB）、血小板（platelet， PLT）、凝血酶原时间（PT）、国际标准化比值（PTINR）］、门静脉内径、门静脉流速、脾静脉内径、Child分级、是否序贯治疗、再出血时间等临床资料。依据5年随访期间是否发生再出血，将所有患者分为未再出血组（n = 124）与再出血组（n = 57）。分别采用单因素和多因素分析影响内镜治疗后5年再出血的危险因素，采用Kaplan-Meier分析1、3、5年的累积出血率。 结果 单因素和二元logistics回归分析得TBIL、门静脉内径均为EGVB患者内镜治疗后5年再出血的危险因素（P < 0.05）。KM曲线显示，181例患者中，1、3、5年累积出血人数为41、54、57例，累积出血率为22.65%、29.83%、31.49%。 结论 肝硬化EGVB内镜治疗后远期再出血率较高，TBIL和门静脉内径是肝硬化EGVB内镜治疗后远期再出血的独立危险因素，对于TBIL和（或）门静脉内径较高的肝硬化EGVB内镜治疗患者的随访需给予高度重视。

Objective To investigate the factors influencing gastrointestinal bleeding associated with esophagogastric fundal varices bleeding （EGVB） in patients with liver cirrhosis 5 years after endoscopic treatment. Methods A retrospective enrollment was conducted on 181 patients with liver cirrhosis who underwent endoscopic treatment with EGVB at the First Affiliated Hospital of University of Science and Technology of China from February 2017 to May 2019， followed up for a minimum duration of 5 years. The demographic characteristics including gender， age， etiology of liver cirrhosis （viral， alcoholic， autoimmune， others）， presence of ascites， hepatic encephalopathy severity （none， stage 1 ~ 2， stage 3）， portal vein thrombosis status， occurrence of liver cancer or portal hypertensive gastric disease along with other complications were recorded. Additionally， peripheral blood indexes ［aspartate aminotransferase （AST）， alanine aminotransferase （ALT）， white blood cell count （WBC）， total bilirubin （TBIL）， albumin （ALB）， platelet count （PLT）］， prothrombin time parameters ［prothrombin time （PT） and prothrombin time international normalized ratio（PTINR）］， portal vein diameter and splenic vein diameter measurements as well as Child grade assessment were collected alongside sequential treatment details and rebleeding time. According to the occurrence of rebleeding within 5 years after endoscopic treatment， the 181 cases were divided into two groups： the non?rebleeding group （n = 124） and the rebleeding group （n = 57）. Univariate and multivariate analyses were conducted to identify risk factors associated with rebleeding within 5 years after endoscopic treatment. Additionally， Kaplan?Meier analysis was performed to assess the cumulative bleeding rate at 1， 3， and 5 years. Results The results of both univariate analysis and binary logistic regression analysis revealed that elevated TBIL levels and increased portal vein diameter were significant risk factors for rebleeding within 5 years following endoscopic treatment in patients with EGVB （P < 0.05）. The Kaplan?Meier curve demonstrated that out of the 181 patients， there were 41 cases of cumulative bleeding within 1 year， 54 cases within 3 years， and 57 cases within 5 years， resulting in cumulative bleeding rates of 22.65%， 29.83%， and 31.49% respectively. Conclusions The long?term rebleeding rate remains elevated following endoscopic treatment of EGVB in cirrhotic patients， with TBIL levels and portal vein diameter identified as independent risk factors for long?term rebleeding after endoscopic treatment of EGVB in liver cirrhosis. Therefore， patients with higher TBIL levels and/or cirrhosis should be given priority for endoscopic treatment of EGVB.