A Multicenter Retrospective Analysis On Treatment Of The Bleeding Caused By Rupture Of Esophageal And Gastric Varices In Jilin Province

Background and Objective:Esophageal and gastric variceal bleeding(EGVB) is a familiar and more disease in china,which is the second frequent cause of upper gastrointestinal bleeding and one of serious complications of portal hypertension resulting from cirrhosis.So it is a problem being solved firstly in the clinic to control upper gastrointestinal bleeding in time and effectively. In recent years we have made great progess in treatment of EGVB in the world . Mortality of variceal hemorrhage has declined remarkab- ly. By retrospective analysis of the therapy of EGVB in our province from 2005 to 2006, this article discusses the best one of all kinds of therapeutic measures to draw the best therapeutic measure which is adapt to the situation of our country providing evidence based medicine . Methods:This article carries out retrospective analysis focused on patients who seeked medical services in 6 hospitals of our province because of EGVB during January first, 2005 to May 31st, 2006. After quantifying the data that we investigate, we set up database of the patients by Microsoft Excel.Investigating items include mainly:(1)sex / age;(2) Etiopathogenisis of portalhyp- ertension;(3)Course of hepatic cirrhosis;(4)Course/times /de- gree of EGVB;(5) Diagnostic method of EGVB;(6) Child-pu gh grade of live function;(7)Turnover of patients; (8)Cause of death;(9) Pharmacologic therapy reducing the hepatic venous pressure;(10)Balloon tamponade; (11) Endoscopic scleraotherapy;(12)Endoscopic band ligation; (13)surgical;(14) therapeutic alliance;(15) interventional therapy. To make use of SPSS13.0 managed the data statistically. Rate or constituent ratio signifies numeration data. By chisquare test or exact propability,we compare hemostasis effect of all kinds of therapeutic measures.Results: we take back 1255 case files,which the date of 1248 case files are complete to be able to analyze.1. Eepidemiology: Proportion of Male and femal are respectively 76.2%and 23.8%.The range of age is from 10 to 88 years old and mean age is 54.51±12.11 years old. Course of hepatic cirrhosis is from 0.083 to 48 years and mean course is 5.117±5.223 years,which proportion of cirrhosis sufferer from hepatitis B, hepatitis C, alcoholic hepatitis,other etiological factors and more etiological factors are respectively56.0%, 10.6%,18.0%,7.9% and 7.5%.The pecent of light bleeding, medium bleeding and severe bleeding are respectively 21.4%,52.2%and 26.4%. The pecent of Child-pugh grade of live function A,B and C are respectively38.0%,39.7% and 22.3%.The mortality together is 20.4%,of which the mortali- ty induced by bleeding directly is 8.75%.all kinds of dead causes from high to low in turn were bleeding(41.2%), liver function failure(14.1%),hepatorenal syndrome(12.9%), hepatic encephalopathy(11.8%),multiple facto(r8.2%),other cause (7.1%)and infection(4.7%).2. Comparing hemostasis effect of all kinds of therapeutic measures:the hemostasis achievement ratio is 88.9%,of which using pharmacologictherapy reducing the hepatic venous pressure, balloon tamponade , endoscopic band ligation in emergency , surgical inemergency and therapeutic alliance are respectively 89.7%, 65.0%,87.9%, 90.0% and 98.8%.There are no patients alone used endoscopic scleraotherapy and interventional therapy to stop bleeding.We also don't found the patients prophylacticly used antibiotics. There were significant difference between the hemostasis achievement ratio of different therapeutic measures(P<0.05),but comparing each other ,there are no difference among pharmaco logic therapy, endoscopic band ligation and surgical(P>0.05).There are difference with the rest of therapeutic measures(P<0.005).The hemostasis achievement ratio from high to low in turn:therapeutic alliance, surgical in emergency, pharmacologic therapy , endoscopic band ligation in emergency and balloon tamponade.when we add up in gradation according to different degree of bleeding,there are 249 patients that are successful hemostasis in the group of light bleeding. The achievement ratio of hemostasis is 93.3%. Theachievement ratio of hemostasis of pharmacologic therapy , balloon tamponade , endos copic band ligation and therapeutic alliance are respectively 91.0%, 100.0%,100.0%and 100.0%. There were no patients alone used surgical. The achievement ratio of hemostasis of different therapeutic measures are all high,but no difference (P>0.05);The achievement ratio of hemostasis is 96.8%in the group of medium bleeding.The achievement ratio of hemostasis of pharmacologic therapy ,balloon tamponade , endoscopic band ligation,surgical andtherapeutic alliance are respectively 97.1%, 86.7%,93.3%,100.0%, 100.0%. The achievement ratio of hemostasis of different therapeutic measures were all high,which are significant difference(P<0.05).But comparing each other ,there are difference only between pharmacologic therapy to balloon tamponade and between therapeutic alliance to balloon tamponade(P<0.005).Namely the therapeutic effect of pharmacologic therapy and therapeutic alliance are better than balloon tamponade;The achievement ratio of hemostasis is 70.0% in the group of severe bleeding. The achievement ratio of hemostasis of pharmacologic therapy , balloon tamponade , endoscopic band ligation,surgical and therapeutic alliance are respectively 60.0%,50.0%,80.0%,80.0% and 96.2%,wh- ich are significant difference ( P<0.05 ) .But comparing each other ,there are difference only between therapeutic alliance to balloon tamponade and between endoscopic band ligation to therapeutic alliance(P<0.005),namely the therapeutic effect of therapeutic alliance is better than endoscopic band ligation and balloon tamponade in severe bleeding. Conclusions:1. The cirrhosis from hepatitis B is still mostly etiological factor of EGVB in the now phase of our province,secondly is the cirrhosis from alcoholic hepatitis and thirdly is the cirrhosis from hepatitis C.2. Medium bleeding consists of mostly parts of EGVB. The ratio of light and severe bleeding are respectively 21.4%and 26.4%.3.pharmacologic therapy reducing the hepatic venous pressure is most frequent therapeutic measure of EGVB in the now phase of our province. It isno satisfied for therapy of EGVB to using endoscopic therapy in emergency and is less to use endoscopic scleraotherapy and interven- tional therapy.4.The achievement ratio of hemostasis in our provence in recent two years is 88.9%.5. There are significant difference between the hemostasis achievement ratio of different therapeutic measures,of which therapeutic alliance is most high and balloon tamponade is lowest. The achievement ratio of hemostasis among pharmacologic therapy ,endoscopic band ligation and surgical, but no difference.6.The achievement ratio of hemostasis of different therapeutic measures are all higher in light bleeding,ut no difference. 7.Whether or not bleeding is light or severe, the achievement ratio of hemostasis of therapeutic alliance is most high,so it is best therapy for our clinical doctors to treat EGVB.8. In addition,pysician must cooperate with surgeon.For the patients who are able to bear surgical ,when there is of no effect in nonsurgical,surgical is still a kind of effective measure to stop bleeding.