Observation On Therapeutic Effect Of Dense Ligation For Severe Esophageal Varices In Liver Cirrhosis

BackgroundCirrhosis is a progressive chronic liver disease caused by one or more factors,characterized by diffuse fibrosis,pseudolobules,and regenerated nodules in liver tissue.The patients with compensatory cirrhosis are asymptomatic or less symptomatic.The symptoms of decompensated cirrhosis patients are obvious,mainly including liver dysfunction and portal hypertension.Portal hypertension often leads to esophageal variceal bleeding(EVB),ascites,splenomegaly,hypersplenism and other complications.EVB is the most common serious complication in liver cirrhosis.Studies have shown that 5% of patients with no varicose veins of liver cirrhosis will develop to esophageal varices(EV)after 1 years and it will be 28%after 3 years.50% patients with cirrhosis will happen EVB during the follow-up period.The annual incidence of EVB is 5%~15%,and the mortality rate in 6 weeks can reach 20%.The risk factors of EVB include the degree of esophageal gastric varices,red signs,liver function.Therefore,The more severe esophageal varices,the greater the risk of EVB.There are many treatments options for EVB,Including drugtherapy,endoscopic treatment,transjugular intrahepatic stent shunt,Sengstaken-Blakemore tube surgery,etc.With the development of endoscopic technology,endoscopic variceal ligation(EVL)has become the preferred strategies for prevention and treatment of esophageal varices.ObjectiveThrough retrospective analysis of the therapeutic effect of dense ligation of severe esophageal varicose bleeding under endoscope to provide reference for clinicians.Method1.114 patients of liver cirrhosis with severe esophageal varices were selected in in the First Affiliated Hospital of Zhengzhou University from July 2014 to June 2017.All the patients were treated with endoscopic treatment.They were divided into two groups because of their different therapeutic method.In the dense ligation group,the distance between two adjacent ligations of each esophageal varices was about0.5cm,or esophageal varices were ligated in the same level around the wall of the esophagus.The number of loop ligature collar was larger than eight in the dense group,while it was less than seven in the non-dense group.In the non-dense group,the distance between two adjacent ligations of each esophageal varices was about 2.0cm.2.The data obtained were statistically analyzed by SPSS 22.0.The quantitative data was expressed as mean±standard deviation(sx ±).If the quantitative data conformd to the normality and homogeneity of variance,t-test was performed.If the normality or homogeneity of variance were not satisfied,the rank sum test wasperformed.The qualitative data was analyzed by chi-square or rank sum test.The difference was statistically significant if P<0.05.Result1.In general information,there was no significant difference in the ratio of male to female,average age,the causes of cirrhosis and liver function each group(P >0.05).The data of the two groups were comparable.2.In the dense ligation group,the average ligation was(13.32±2.21)ligature points for the first time.The disappearance rate of esophageal varices was 18.8% and the total effective rate was 92.7% after the first treatment.In the non-dense ligation group,the average ligation was(5.98±1.16)ligature points for the first time.The disappearance rate of esophageal varices was 6.7% and the total effective rate was71.1% after the first treatment.The difference was statistically significant(Z=-3.227,P=0.001<0.05).3.In the dense ligation group,there were 13 cases for one treatment,29 cases for two treatment,20 cases for three treatment and 5 cases received the fourth treatment12 weeks after the third treatment.The average number of treatment was 2.2 times.In the non-dense ligation group,there were 3 cases for one treatment,11 cases for two treatment,15 cases for three treatment and 10 cases received the fourth treatment 12 weeks after the third treatment.6 patients did not continue to receive trement after the third treatment though the esophageal varices did not disappear.The average number of treatment was 2.9 times.The average number of treatment in the dense ligation group was less than that in the non-dense ligation group.The difference was statistically significant(P<0.05).4.Early rebleeding rate in the dense ligation group was 13.0%(8/69).The rate of early rebleeding in the non-intensive ligation group was 15.6%(7/45).There was no significant difference between the two groups in the early rebleeding rate(P>0.05).The mortality rate in the dense ligation group was 2.9%(2/69).There was no significant difference between the two groups in the mortality rate(P>0.05).In the dense ligation group,87.0%(60/69)of the patients showed different degrees of throat discomfort,nausea,vomiting,chest pain,fever and other adverse reactions,while there were 73.3%(33/45)of the patients showed adverse reactions in the non-dense ligation group.All patients achieved remission of symptoms after medicine treatment.There was no significant difference between the two groups in the postoperative adverse reactions(P> 0.05).5.In the dense ligation group,the recurrence rate of esophageal varices after treatment was 36.2%(25/69)in six months,while that was 40.0%(18/45)in the non-dense ligation group.There was no significant difference(?2 = 0.769,P = 0.381 >0.05).ConclusionDense ligation in the first treatment of severe esophageal varices is a safe and effective treatment.Compared with non-intensive ligation,Dense ligation can improve the therapeutic effect of severe esophageal varices and reduce the treatment times.But dense ligation can not reduce the recurrence rate of esophageal varices.