Comparison Of Three Treatments For Cirrhotic Portal Hypertension Complicated With Upper Gastrointestinal Bleeding

Objective: To compare the efficacy of three treatments:conservative treatment,endoscopic treatment and surgical treatment.Method: From October 2014 to August 2018,322 patients with portal hypertension and gastrointestinal bleeding were treated in the Affiliated Hospital of North Sichuan Medical College.Their condition and treatment were reviewed and analyzed.According to different treatment methods are divided into:Endoscopic group treatment group:142 patients,conservative treatment group:144 patients,surgical group:36 patients.Compare the three groups of treatment methods in the following aspects:clinical hemostasis effect,hemostasis time(24 hours,48 hours,72 hours of hemostasis success rate),72 hours after rebleeding rate,2 years of rebleeding rate,complication rate,Improvement rate and mortality during hospitalization.result:(1)Hemostasis:The clinical hemostasis results of the endoscopic treatment group and the surgical treatment group were better than those of the conservative treatment group(P<0.05).(2)Hemostasis time:1 Under the same liver function grading condition:When the liver function was graded A,the success rate of hemostasis in the conservative treatment group was 68.0%,which was lower than that in the endoscopic treatment group(P<0.05);At grade B,the success rate of hemostasis in the conservative treatment group was lower than that in the endoscopic treatment group(P<0.05)in 24 hours,48 hours,and 72 hours,and the success rate in the surgical treatment group was 78.3%in 24 hours,which was more than endoscopic treatment.The success rate of the group was 92.6%(P<0.05).When the liver function was grade C,the success rate of hemostasis at 24 h,48h and 72 h in the conservative treatment group was lower than that in the endoscopic treatment group(P<0.05).2 Under the same bleeding degree classification:in mild bleeding,the success rate of hemostasis at 24 h and 48 h in the conservative treatment group was lower than that in the endoscopic treatment group(P<0.05);in the moderate bleeding group,24 hours and 48 hours in the conservative treatment group,The success rate of hemostasis in 72 hours was lower than that in the endoscopic treatment group(P<0.05).The success rate of hemostasis in the endoscopic treatment group was lower than that in the surgical group(P<0.05).(3)72-hour rebleeding rate:the incidence of recurrent bleeding in the conservative treatment group was 20.4%,which was significantly higher than that in the endoscopy(1.4%)and the surgical group(0%),and the difference was statistically significant(P<0.05).(4)Recurrence rate of rebleeding within 2 years:the recurrence rate of the conservative group was 76.1%higher than that of the endoscopy group,and the recurrence rate of the endoscopic group was higher than that of the surgical group(8.3%)(P<0.05).Further comparison of the 2-year recurrence rate under the same liver function classification:when the liver function was grade A,the rebleeding rate in the conservative treatment group was 60.0%within two years,higher than the endoscopic treatment group(8.3%)and the surgical group(0.0%).),and the difference was statistically significant(P<0.05);when the liver function was graded B,the rebleeding rate was 74.7%in the conservative treatment group within two years,higher than the endoscopic treatment group(23.2%)and the surgical group(8.7%),and the difference was statistically significant(P<0.05);when the liver function was grade C,the recurrence rate was higher in both the conservative group and the endoscopy group,and the rebleeding rate was 96.2%in the conservative treatment group within two years.Higher than the endoscopic treatment group(52.0%),and the difference was statistically significant(P<0.05).(5)The incidence of complications of hepatic encephalopathy,infection and thrombosis:The incidence of complications in the surgical group was the highest,44.4%,higher than the endoscopic treatment group and the conservative treatment group,and the difference was statistically significant(P<0.05).(6)The mortality rate of patients during hospitalization:the mortality rate of conservative treatment,endoscopic treatment and surgical treatment were 9.2%,0.7%,5.6%;the mortality rate of the conservative treatment group was higher than that of the endoscopic treatment group,and the difference was Statistical significance(P<0.05).Conclusion:(1)Hemostasis effect:Under the same grading of liver function and bleeding degree,the hemostasis effect of drug conservative treatment(clinical hemostasis effect,hemostasis time and rebleeding rate after 72 hours)was worse than that of endoscopy and surgery,and the hemostasis effect was more easily affected by liver function and bleeding degree of patients;while endoscopy and surgery treatment were at the same level of liver function(Child A,B)and the same level.Comparing the degree of bleeding(mild and moderate bleeding),the hemostatic effect of the two treatments was satisfactory,and there was no significant difference between the two treatments.(2)Hemorrhage recurrence rate:among the three treatments,conservative treatment has the highest recurrence rate in 2 years,followed by endoscopic treatment;Although endoscopic treatment has a wide range of applications and good hemostasis effect,it can not reduce portal vein pressure very well,so its recurrence rate is high,and the long-term treatment effect is not as good as surgical treatment.(3)Complications: Surgical treatment is more prone to hepatic encephalopathy,infection,thrombosis and other complications.(4)Mortality rate:The mortality rate of conservative treatment during hospitalization was higher than that of endoscopy and surgery,but there was no significant difference between endoscopy and surgery during hospitalization.