| Objective: To explore whether it is a safe and effective treatment for patients with severe esophageal varices by injecting polidocanol and small dose tissue glue with the help of endoscopy.Methods: This study adopted a retrospective cohort study,and set up 2 groups,namely the study group and the control group.The subjects included patients with severe esophageal varices in our hospital from January 1,2020 to June 30,2021.According to different surgical methods,the diameter of varicose veins should be between 1 cm and 2 cm.The patients were divided into observation group(polidocanol group combined with low-dose tissue glue group after injection)and control group(only polidocanol injection under endoscope).According to the inclusion and exclusion criteria,a total of 88 patients with severe esophageal varices were included.The matching factors of propensity score were set up,including gender,age,causes of liver cirrhosis,esophageal varices morphology,varices diameter and child Pugh classification.After propensity score,21 pairs were successfully matched.The follow-up methods mainly included telephone notification and endoscopic observation.There are two main indicators.One is the safety indicator,including intraoperative bleeding rate,postoperative bleeding rate and complication rate.The benefit indicator includes esophageal varices remission rate.Other indicators include time and economic benefits.The input method is excel 2016,and the statistical analysis is spss25.0software.The measurement data of normal distribution are expressed by x ± s,and the counting data are expressed by median(interquartile spacing).The measurement data between the two groups were analyzed by independent sample T test,the disordered counting data were analyzed by x2 test,and the data of different categories and grades were compared by rank sum test.P < 0.05 means the difference is statistically significant.Results:In the study group,20 patients were remissed and 1 patient had no remissed.The remission rate of esophageal varices was 95.2%.In the control group,13 patients were remissed and 8 patients did not remissed,the remission rate was 61.9%,There were differences between the two groups(P=0.008).The diameter of esophageal varices in the study group was reduced by 0.74±0.40 cm compared with that before the first operation,the diameter of the varices in the control group was reduced by 0.47±0.38 cm compared with that before the operation,and the difference was statistically significant(P=0.028).In the study group,7 patients had rebleed within six months,and the rebleed rate was 33.3%.In the control group,5 patients had rebleed,and the rebleeding rate was 23.8%(P=0.495).There was no difference in the rebleeding rate between the two groups.There were differences in intraoperative bleeding between the study group and the control group(4.8% versus 38.1%,P=0.008).According to the occurrence of complications.The complications in the study group were as follows: ectopic embolism in 0 cases,esophageal ulcer in 5 cases(no bleeding was found in all glue discharge ulcers under direct endoscopy),esophageal stenosis in 0 cases,chest pain in 0 cases and fever in 2 cases.The complications in the control group included 0cases of ectopic embolism,0 cases of esophageal ulcer,0 cases of esophageal stenosis,0cases of chest pain and 1 case of fever.There was no difference between the study group and the control group in terms of operation cost,operation time,number of operations within half a year,total hospitalization cost,number of hospitalizations,and length of each hospitalization.Conclusion:Endoscopic treatment of cirrhosis type F3 esophageal varices with polidocanol combined with low-dose tissue glue injection can effectively alleviate esophageal varices in a short period of time,and this study concluded that compared with the simple polidocanol injection treatment,it will not enhance the risk of occurrence,but the number of cases is relatively small,more rigorous research conclusions need large sample,multi center research can still support the risk related conclusions.As far as this study is concerned,it can be considered that the combination of polidocanol and tissue glue injection is relatively safe. |
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