The Analysis Of Prognostic Factors For Cirrhotic Esophagogastric Variceal Bleeding In PHT Treatment By Transcatheter Embolization

Objective To analysis of prognostic factors for patients with cirrhotic PHT by combiningpercutaneous transhepatic obliteration (PTO) varices with PSE. The reasons of re-bleeding wereexplored after our operation and the relationship between various factors and the varicealoutcome,bleedingrecurrenttimeandsurvivaltimewereanalysedandinterventionstudy.Materials and methods 73 cases of bleeding patients with liver cirrhosis and PHT werestudied prospectively. Our treatment combined PTO and PSE,We observed the reaction andcomplication, followed-up the variceal outcome, rebleeding time and survival quality after theprocedure. Choose 13 factors among the total of possible correlation factor is objection of study. Weused Spearman relationship analyze, ANOVAtest, Logistic proportional hazard model and COXproportional hazard model to analyze 15 factors concerning variceal outcome, rebleeding timeand survival time. And we compared photographic image, hsmodynamics before and afterrebleedingtoanalyze.Results①The main complication are temporary fever 62 cases(84.9%), bellyache andabdominal swelling 48cases(65.8%). And There was no serious complication;②In the course ofinterventional therapy, Direct portal vein angiography demonstrated vena coronaria ventriculi(100%)andgastricveins(65.26%)andvenagastricaposterior(38.43%, Angiography demonstrated venacoronariaventriculi communicate esophagus varicose veins, gastric veins and vena gastrica posterior communicategastric varicose veins. vena coronaria ventriculi had only a small percentage of double vein, about30.57%. The sites of vena coronaria ventriculi arising from the portal vein, splenic vein, portosplenic junction, were found in 52.06%,27.39%,20.55% respectively.③12 extrahepaticprotosystemic shunts were found in these patients. Include gastro-nephrosshuntof 3 cases, 7 caseswere splenetic- nephros shunt and 2 cases shown recanalization of umbilical vein .④The averageportal pressure before and after the procedure were 3.87±1.82kPa and 3.64±1.14kPa in 73patients, but to the time of rebleeding, it was 3.96±0.23kPa in the 11 cases.⑤There werethree kinds of variceal outcome: disappearance (54),low degree (19).⑥Spearman logisticanalyse and ANOVAtest shown liver function class, variceal degree of the splenic necrosis area,the blood direction in portal vein before operation and remain small collateral routes were thesignificant factors concerning outcome of varices.⑦The bleeding volume and portalhypertensive gastropathy (PHG) are main risk factors of rebleeding.⑧The course of livercirrhosis is the risk factor of survival and extrahepatic portosystemic shunt , fine varices are thebeneficial factors to survival.⑨During all cases'followed-up data, the 1, 2, 3, 4, 5 yearcumulative survival rates and rebleeding rates were 17.81%, 28.77%, 38.36%, 43.84%, 47.95%and93.15%,91.78%,86.30%,83.56%,80.82%respectively.Conclusion The interventional disconnection treatment for liver cirrhosis and portalhypertension was designed suitability. It rapidlycontrol bleeding,butpressure of portal vein was notobvious high, perfusion was not low .it was compared with surgery therapeutic that interventionaldisconnection treatment was safe and had a significant clinical effect to hemorrhage and preventfrom rebleeding. It was factors of Hepatic function, portal pressure of preoperative and PHG that wasmanaged.Thusactivetherapywouldenhanceprognosisoftheinterventional disconnection treatment.