| Objective:Following-up for two years after endoscopic variceal ligation(EVL) or endoscopic injection sclerotherapy (EIS) in Liver cirrhosis patients with esophageal varices bleeding(EVB), to compare the effect of EVL group with EIS group, and to prospectively determine the risk factors of prognosis after endoscopic therapy.Methods:Collecting106cases of liver cirrhosis patients with esophageal varices bleeding In the first affiliated hospital of Anhui medical university digesting internal medicine from January2005to December2010,.8cases lost to following-up and3cases were excluded for the diagnosis of primary liver cancer by December2012. Finally95cases were qualified liver cirrhosis patients with esophageal varices bleeding,47cases in EVL and48cases in EIS. All the patients were set using the unified hospital registration information table, with a detailed record of the patient’s clinical information and the laboratory test results. Each of the patients was followed-up for two years after the first endoscopic therapy. To detailed record condition changes in the follow-up period. To inject hardener in varicose vein since the cardiac in EIS group, and to decide the injection quantity each point according to varicose vein varicose degree. Generally,5-10ml each point,2-6point every time, and the amount of all is not more than forty ml. To TaoZa varicose vein from dentate line with a screw, and to decide the points and frequency according to the degree of varicose veins in EVL group. Usually,1-7points every time. There is a3-4weeks interval to do endoscopic therapy again, according to patients’condition and varicose veins degree. There is a following-up six weeks later, then once every3months, until2years. To compare the treatment effect in two groups from hemostatic success rate, rebleeding rate, complications and so on. At the same time,95cases is divided into death group (n=24) and survival group (n=71) in accordance with the outcome during the follow-up period. To discuss the related factors and individual factors that influencing patients’prognosis after endoscopic therapy according to comparing with the difference between death group and survival group in the gender, age, etiology, ascites degree, liver function classification, biochemical index, gastroscope manifestation, imaging findings, treatment methods, postoperative rebleeding postoperative infection and so on.Results:The analysis of treatment effect between EIS group and EVL group: Hemostatic success rate and late-occurred rebleeding was higher in EVL group than EIS group (97.5%VS87.5%,34.04%VS22.92%), early rebleeding was higher in EIS group (56.25%VS40.43%), but the differences had no statistical significance (P>0.05). Early bleeding rate and fatality rate in EIS group was higher (33.33%vs6.38%,37.5%vs12.77%), and the difference was significant (P<0.05). Complications comparition:Fever, hot days, failure rate of Emergency hemostatic and hepatic encephalopathy were higher in EIS. There were3cases with esophageal ulcers and4cases with pleurisy after EIS, there was not in EVL group, but the differences had no statistical significance (P>0.05); Retrosternal pain or discomfort and abdominal distension were significantly higher in EIS group while eating choking was significantly higher in EVL group (P<0.05). The analysis of risk factors affecting the prognosis:Single factor analysis show the differences in age, liver function Child Pugh classification, bleeding degree, ascites degree, prothrombin time, treatment, early rebleeding, rebleeding, rebleeding times, merger fundic varices, postoperative infection and plasma albumin were significant between death group and live group (p<0.05); Many factors Logistic regression analysis show that liver Child-Pugh classification, bleeding degree, PT, treatment method, merger fundic varices, plasma albumin, early rebleeding eliminated out the equation, are confounding factors that affect the prognosis of endoscopic therapy; Age, rebleeding, rebleeding times and degree of ascites retained in the regression equation, are the independent factors. Eespecially, rebleeding influence is the most significant.Conclusion:1EVL and EIS are the effective methods to treat esophageal varicose vein rupture hemorrhage. The effect of EVL treatment may be superior to EIS for the patients of esophageal varices bleeding.2Infection, prothrombin time, plasma albumin, age, liver function classification, bleeding degree, ascites degree, treatment, early rebleeding, rebleeding, rebleeding times and merger fundic varices are the related factors that affect the prognosis of endoscopic therapy.3Rebleeding, rebleeding times and ascites degree are independent risk factors that affect the prognosis of endoscopic therapy, and rebleeding influence is the most significant. |
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