Clinical Observation Of Endoscopic Variceal Ligation In The Treatment Of Gastric Varices

Objective：To observe the therapeutic effects of endoscopic varicealligation (EVL) in the treatment of different types of gastric varices(GV),detect the factors of recurrence and rebleeding after EVL.Method：Retrospective analysis of101GV cases treated by EVL, therewere respectively63cases of gastroesophageal varices type1(GOV1),18cases of gastroesophageal varices type2(GOV2),11cases ofGOV1coexisting with GOV2,9cases of isolated gastric varices type1(IGV1)and0cases of isolated gastric varices type2(IGV2). In the follow-up for5.5～53.0months(30.14±15.08months for average), compare the successrate of hemostasis, early rebleeding rate, late rebleeding rate, totalrebleeding rate, elimination rate and recurrence rate. CT or CTA wasperformed in34patients, observe the supplying veins, gastrorenal orsplenorenal shunts, measure the portal vein diameter, splenic vein diameterof different types of GV, and analyze their relationships with recurrence ofGV. Each measurement data was analyzed by ANOVA, enumeration datasample rate was analyzed by chi-square test or Fisher exact probabilities,ranked data was analyzed by rank sum test. Kaplan-Meier analysis was usedto examine the time of first recurrent bleeding, and the log-rank test was usedto compare differences among the groups. Univariate and multivariateregression analyzes the factors of rebleeding after EVL. Results：GOV2, IGV1varices were more severe than GOV1(the valuesof μ were-2.960and-2.871respectively, P<0.05). There was no statisticalsignificance for rebleeding rate among different types (χ2=1.822，P=0.610).The recurrence rate of GOV1is lower than other types of GV. The CT orCTA showed that all the GV were supplied by left gastric veins,83.3%ofIGV1had blood supplement by left gastric veins, and short gastric orposterior gastric veins,100%of IGV1had gastrorenal or splenorenal shunts,the ratios were higher than other types of GV’s. Portal vein diameter, splenicvein diameter of different types of GV had no statistical significance (thevalues of F were1.243and0.264respectively, P＞0.05).55.9%(19/34) ofGV had gastrorenal or splenorenal shunts, the portal vein diameter betweenthe groups with or without gastrorenal or splenorenal shunts had statisticalsignificance(t=-2.766，P＜0.05), but the splenic vein diameter had nostatistical significance (t=-1.929，P＞0.05). The recurrence rate of the groupwith or without gastrorenal or splenorenal shunts was57.9%,26.7%respectively. Multivariate regression indicated hepatocellular carcinoma（RR=8.319，95%CI：7.012-9.851，P＜0.01）and activated partialthromboplastin time （APTT）(RR=1.032，95%CI：1.014-1.050，P＜0.01) were two independent risk factors determining GV’s rebleeding afterEVL.Conclusions： EVL can effectively control bleeding and preventrebleeding for GV. Among all the types of GV, GOV1treated by EVL getsthe best effect, with low recurrence rate. GV with gastrorenal or splenorenalshunts are more likely to be recurrent. Hepatocellular carcinoma and APTTare two independent risk factors of determining rebleeding.