The Effect Of Endoscopic Variceal Ligation On Haemodynamics Of Portal Systom And Liver Function

ObjectiveIn this study, combine color doppler ultrasonography imaging with gastroscope to observe the change of esophageal varices degree between before endoscopic variceal ligation(EVL) with after EVL,and measure the diameter and blood flow velocity of hepatic portal vein(PV) and splenic vein(SV),then calculate flow of hepatic portal vein and splenic vein,through this way,to study the results of EVL,explore the changes of haemodynamics of portal system after EVL, and combine with the observation indexes, judge EVL effect on liver function. MethodsCollected 53 patients data from Gastroenterology in the affiliated Hospital of Yan’an University since February 2013 during February 2015,who diagnosed esophageal varices caused by cirrhosis of liver and did EVL during hospitalization.(一)Observing the change of esophageal varices degree between before EVL with after EVL by gastroscope to evaluate the efficacy of treatment.(二)Using color doppler ultrasonography imaging measure portal vein diameter(PVD)、portal vein blood flow velocity( PVVmax)、splenic vein diameter(SVD)、splenic vein blood flow velocity(SVVmax) from 53 patients those are esophageal varices caused by cirrhosis of liver,calculate sortal vein blood flow(PVF)、splenic vein blood flow(SVF)、PVVmean、SVVmean,whether there were significant differences after comparing various data before EVL with after EVL.(三)Comparing various data before EVL with after EVL that record platelet count(PLT), albumin(ALB), serum total bilirubin(STB), prothrombin time( PT), serum sodium(Na+) 、creatinine(Cr)from each patient whether have significant differences.(四)According to the formula to calculate MELD and MELD-Na score, respectively to compare the two in the presence of significant difference before and after EVL. Results(一)The efficacy of treatment by EVL:53 EVL patents reviewed by gastroscope during 14-20 days after the EVL surgery, There were 535 ligation points, the average of ligation points is 10.10 ± 4.66.The rate of successful EVL is 100%(53/53). 14 patents had obvious effect(26.42%,14/53).35 patents had effect(66.04%,35/53),4 patents had no effect(7.55%,4/53).(二)The change of hemodynamics before and after EVL:53 EVL patents were all scanned PV and SV by color doppler ultrasonography imaging before and after surgery(100%).The change of PVD before and after EVL.the average of PVD from each patent is(13.99±1.97)mm before EVL.The average of PVD from each patent is(14.05±1.87)mm after EVL.There were no statistically significant differences between them(P>0.05).The mean PVV of patients before EVL(12.13 ±3.46)cm/s were obviously faster than after EVL(12.55±3.55)cm/s, the difference between the change of PVV in before and after EVL were statistically significant(P<0.05). The mean PVF of patients before EVL(1195.50±627.83)ml/min were more than after EVL(1245±651.09)ml/min, the difference between the change of PVF in before and after EVL were statistically significant(P<0.05).The mean SVD of patients before EVL(10.39±2.47)mm were wider than after EVL(10.87±2.36)mm,but the difference between the change of SVD in before and after EVL were no statistically significant(P>0.05).The mean SVV of patients before EVL(12.89±4.16)cm/s were obviously faster than after EVL(13.45±3.95)cm/s, The difference between the change of SVV in before and after were statistically significant(P<0.05). The SVV of each group before EVL(12.89±4.16)cm/s were obviously faster than after EVL(13.45±3.95)cm/s, the difference between the change of SVV in before and after were statistically significant(P<0.05). The SVF of each group before EVL were obviously faster than after EVL(13.45±3.95)cm/s, the difference between the change of SVV in before and after were statistically significant(P<0.05). The SVF of patients before EVL(770.14±521.32)ml/min were more than after EVL(845.02±516.30)ml/min, the difference between the change of SVF in before and after were statistically significant(P<0.05).(三)Changes in various data before and after EVL:The difference among in PLT(58.03 ± 33.25)109/L, STB(28.94 ± 16.32)umol/L, PT(17.94 ± 3.43)s, before EVL were no statistically significant with PLT(63.39 ±39.18)109/L, STB(26.34 ± 14.01)umol/L, PT(17.20 ± 3.17)s after EVL(P > 0.05).The difference between ALB before EVL(30.68±4.44)g /L with ALB after EVL(34.53±3.49)g /L、Na+ before EVL(140.41±3.80)mmol/L with Na+ after EVL(138.47±4.00)mmol/L were statistically significant(P<0.05).(四)Changes in MELD and MELD-Na scores before and after EVL:The difference between MELD score before EVL(10.55±5.14) with MELD score after EVL(7.80±5.25)、MELD-Na score before EVL(10.70±4.42)with MELD-Na score after EVL(8.63±5.85) were statistically significant(P<0.05). Conclusions: 1 EVL is a safe and effective means to prevent and treat esophageal varices bleeding(EVB). 2 EVL had some influence on hemodynamics of portal vein which were mainly manifested on than PV and SV Blood speeding became faster and increase the blood flow,increase the flow of blood to the liver through color doppler ultrasonography imaging found, but there were no different in diameter of PV and SV after EVL,that means EVL can increase the blood supply of the liver, B ultrasound can be used as evaluation of the patients with EVL of portal hemodynamic examination method. 3 By comparing Various observed indicators before and after EVL found that ALB increased、Na+ to reduce, the difference was statistically significant,but there was no statistically significant in PLT, STB, PT,prompt EVL may not worsen the liver function. 4 MELD and MELD-Na scores before and after EVL by calculation,to found EVL to MELD and MELD-Na scores have a certain influence, both the scores significantly decreased after EVL, EVL is beneficial to the improvement of liver function.