| Objective1. The clinical effect of endoscopic tissue adhesive combined with lauromacrogol by modified sandwich method compared with the traditional sandwich method for the treatment of gastric varices(GV) were retrospectively analyzed.2. To study risk factors of re-bleeding after endoscopic tissue adhesive injection. Methods1. A retrospective study was performed to review the clinical and follow up data of 246 patients who were diagnosed with GV and initially received tissue adhesive injection from June 2010 to December 2014, which were divided into group A treated with traditional sandwich method and group B treated with the modified sandwich method. Then compare the hemostatic effects, improvement of GV, conditions of re-bleeding and complications between two groups.2. Clinical data for 182 patients with GV bleeding who were initially received tissue adhesive injection between June 2010 and December 2014 were retrospectively analyzed. Record gender, age, types of cirrhosis, coexistent of hepatocellular carcinoma, coexistent diseases(hypertension, diabetes), hepatic encephalopathy, the use of antibiotics/lauromacrogol, Child-Pugh class, the GV class(Sarin class), whether were the emergency treatment, the large of GV(F1?F2?F3), presence of portal vein thrombosis, ascites, diameter of portal portal vein, spleen length/thickness, liver/renal/coagulation function tests, routine blood tests, blood transfusion volume, experience of doctors(endoscopic operation number < 2000 cases or ? 2000 cases). Then we divided patients into re-bleeding group and no re-bleeding group to explore the postoperative potential risk factors of re-bleeding. Results1. The hemostatic rates of two groups were 99.0%, 99.3% respectively(P < 0.05). Group A: the eradication rate of GV was 21.2% and the time of eradication was 1-16 months(8.36 ± 3.23), the effective rate was 39.4% and the time of remission was 1-12 months(5.82 ± 2.43), while the total effective rate was 60.6%; Group B: the eradication rate of GV was 35.9% and the time of eradication was 1-20 months(5.92 ± 3.51), the effective rate was 38.7% and the time of remission was 0.5-13 months(3.81 ± 2.66), while the total effective rate was 74.6%. The eradication rate and total effective rate of group B were higher than group A, and the time to eradicate and remit varices of group B was much shorter(P < 0.05). Furthermore, the improvement and overall effectiveness of type GOV2 in group B were significantly higher than that in group A(P < 0.05), and no difference was found between the rest types. The re-bleeding rates of two groups were 36.5%, 31% respectively(P < 0.05). 1 patient in group A developed pulmonary embolism while no one appeared in group B. The ulceration rate of group B was significantly higher than that of group A, and the other complications were no difference.2. 182 patients were followed for 0.5 ~ 38 months, including no re-bleeding group and re-bleeding group. Single factor analysis showed that the gender, causes of liver cirrhosis, Child-Pugh class, spleen length, experience of doctors and serum albumin level(ALB) between groups had statistically difference. The areas under the ROC curve of spleen length and ALB were 0.703 and 0.708, of which sensitivities were 56.7%, 76.7% and specificities were 76.2%, 54.9%. Logistic regression analysis showed that the spleen length, ALB, experience of doctors and Child-Pugh class were independent risk factors associated with re-bleeding after tissue adhesive injection [P = 0.000, 0.001, 0.001, 0.022; odds ratio(OR)= 5.077, 0.243, 0.239, 2.195; 95% confidence interval(CI) = 2.337-11.031, 0.108-0.550, 0.550-0.557, 1.123-4.290]. Conclusions1. For the treatment of GV, endoscopic tissue adhesive combined with lauromacrogol by modified sandwich method injection which also has safety is more effective than traditional endoscopic tissue adhesive injection.2. The spleen length, ALB, experience of doctors and Child-Pugh class significantly influence re-bleeding after endoscopic tissue adhesive injection for GV, and high-risk re-bleeding groups need to be taken prevention measures or treated in order to improve treatment effect. |
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