The Curative Effects Analysis Of Different Treatment Of Esophageal And Gastric Variceal Bleeding In Liver Cirrhosis

Objective:To explore the therapeutic effect of esophageal and gastric variceal bleeding(EGVB)in liver cirrhosis by the endoscopic treatment and surgical treatment(splenectomy and pericardial devascularization),and analyze the related risk factors that affect the therapeutic effect,providing reference for clinical treatment of upper gastrointestinal hemorrhage caused by liver cirrhosis.Methods:Retrospective analysis was performed on 112 patients with complete case data and follow-up information,hospitalized in the First Hospital of Jilin University from January 2016 to January 2019 due to liver cirrhosis and EGVB.According to the different treatment,the patients were divided into two groups: endoscopic group(60 cases)and surgical group(52 cases).Basic information,clinical data and laboratory results of each patient were collected.We followed up the patients by telephone and recorded the rebleeding,survival and complications of each patient after treatment.SPSS 22.0 statistical software was used for statistical analysis to compare the rebleeding rate,survival rate and complication rate of the two groups,and to analyze the predictors of rebleeding and survival.Results:(1)The rebleeding rates within 1 month,6 months,and 1 year in the surgical group were 1.9%,3.8%,and 9.6%,and those in the endoscopic group were 15.0%,20.0%,and 26.7%,respectively.The differences in rebleeding rate between the two groups within 1 month,6 months and 1 year were statistically significant(P<0.05).Multivariate logistic regression analysis showed that treatment was an independent predictor of rebleeding,surgical treatment could reduce the risk of rebleeding compared with endoscopic treatment.The risk of rebleeding in the surgical treatment was 0.293 times that of the endoscopic treatment(OR=0.293,95%CI=0.099~0.866,P=0.026).(2)Kaplan Meier analysis showed that the cumulative survival rates of 1,2 and 3 years in the surgical group were 98.1%,90.4% and 85.6% respectively,while those in the endoscopic group were 90.0%,80.6% and 72.6% respectively.There was no significant difference between the two groups(log rank test,P=0.142).Cox regression analysis showed that rebleeding(P=0.028,HR=4.220,95 % CI=1.164~15.296),Child-Pugh grade(P=0.017,HR=2.802,95%CI=1.206~6.507)and MELD score(P=0.003,HR=1.238,95%CI=1.078~1.422)were independent risk factors for survival.(3)The incidence of postoperative complications in the surgical group(51.9%)was significantly higher than that in the endoscopic group(31.7%),the difference was statistically significant(P<0.05),and the types of complications in the surgical group were more than those in the endoscopic group.Conclusions:(1)Surgical treatment is better than endoscopic treatment in preventing rebleeding,but the incidence of complications after surgical treatment is higher than that of endoscopic treatment.(2)The treatment was an independent prognostic factor of rebleeding.Surgical treatment could reduce the risk of rebleeding compared with endoscopic treatment.(3)Rebleeding,Child-Pugh grade and MELD score were independent risk factors for survival.