Study On The Treatment Of Tissue Adhesive Combined With Lauromacrogol For Gastric Varices

Objective1. To investigate the importance of digital subtraction angiograpgy(DSA) in studying the supplier of blood and the classification of esophagogastric varices.2. To study the classification of esophagogastric varices and its importance of the clinical effect. To evaluate the clinical effect and the extrusion rule of tissue adhesive combined with lauromacrogol on gastric varices, and to evaluate the efficacy and safety. MethodsA total of 171 patients who had a history of bleeding caused by portal hypertension were examined by gastroscopy were analyzed. All patients were classified into different types of esophagogastric varices systematically. 60 cases of patients underwent DSA,to studying the the supplier of blood and the relationship with the classification of esophagogastric varices. Tissue adhesive combined with lauromacrogol(Combination therapy group) was done for 101 cases, and tissue adhesive(Histoacryl group) 70 cases. The patients were followed up in week 1, week 2, month 1, month 2, month 3, month 6, month 9, year 1. Then the hemostatic effects, improvement of gastric varices, the conditions of rebleeding, the relevant factors of rebleeding, the extrusion rule of glue and the clinical adverse reactions were compared in the two groups. Results1. Among the 171 cases, there were 51cases(29.82%) of GOV-1, 79 cases(46.20%) of GOV-2, 41 cases(23.98%) of IGV-1. Comparing the constituent ratio of the classification of esophagogastric varices, there were no statistical difference between Combination therapy group and Histoacryl group(P<0.05).2. In the 60 cases underwent DSA, the endoscopy confirmed 14 cases(23.33%) of GOV-1, 43 cases(71.67%) of GOV-2, 3 cases(5.00%) of IGV-1. In the patients of GOV-1, 9 cases(64.29%) of GOV-1 were mainly nourished by gastric coronary vein and 5 cases(35.71%) mainly by short gastic vein. In the 43 cases(71.67%) of GOV-2, 21 cases(48.83%) were mainly nourished by short gastic vein and16 cases(37.20%) mainly by splenogastric vein, 6 cases(13.95%) mainly by gastric coronary vein. In the 3 cases(5.00%) of IGV-1,2 cases(66.67%) were mainly nourished by short gastic vein,1 case(33.33%) mainly by gastric coronary vein.3. The hemostatic rate in GIS group and Histoacryl group were 100%. The follow-up period was 1~24mo(7.47mo±6.04 mo) in Combination therapy group. The remission rate of gastric varices was 45.54%, the eradication rate of gastric varices 27.72% and the total efficacy 73.26% in Combination therapy group. The follow-up period was 1~26mo(12.17mo±8.01mo) in Histoacryl group. The remission rate of gastric varices was 28.57%, the eradication rate of gastric varices 24.29% and the total efficacy 52.86% in Histoacryl group. The efficacy of gastric varices in Combination therapy group was higher than that in Histoacryl group(P<0.05). The mean time of remission in Combination therapy group(3.67mo±4.24mo) was ealier than that in Histoacryl group(7.22mo±7.11mo)(P<0.05).4. In reducing and eliminating GOV-2 type gastric varices tumors, the efficacy of gastric varices in Combination therapy group was higher than that in Histoacryl group(P<0.05).5. The rebleeding rate had no statistical difference between Combination therapy group(22.77%) and Histoacryl group(34.29%)(P>0.05). The mean time of rebleeding in Combination therapy group(2.50 mo ± 2.69 mo) was ealier than Histoacryl group(5.56 mo ± 5.26 mo)(P<0.05).6. In Combination therapy group, the glue ratio was 33.3% in month 2, and 35.7% in month 3. In Histoacryl group, The glue ratio was 45.5% in month 1, and 23.8% in month 2. The glue clumping shape is correlated with anatomic structure of vessel, and with assorted colours. The glue is extruded into the lumen in one to three months. The glue eliminated within one year. The ending time of extrusion has no rule to follow. The mean time to rebleeding resulting from extrusion in the Combination therapy group(41.11d±23.57d) was shorter than that in the Histoacryl group(69.80d±26.67d)(P<0.05). ConclusionAccording to this study, the esophagogastric varices of GOV-1 is mainly nourished by gastric coronary vein, GOV-2 and IGV-1 mainly by short gastic vein.Tissue adhesive combined with lauromacrogol are more effective than Histoacryl in improving gastric varices. The rebleeding rate didn’t recreasing, but the mean time of rebleeding and rebleeding resulting from extrusion were earlier in Combination therapy. The glue is extruded into the lumen in one to three months. The glue eliminated within one year.