| Objective Esophagogastric variceal hemorrhage in cirrhosis of the liver is a common critical and critical disease in clinical practice.At present,the treatment for emergency hemorrhage and prevention of hemorrhage mainly includes medical treatment,endoscopic treatment,interventional treatment and surgical treatment.With the continuous development of endoscopic technology and the increasingly mature endoscopic hemostasis technology,the current endoscopic treatment methods include sclerosing agent injection,ligation therapy and tissue glue injection therapy.Ligation or sclerosing agent injection is recommended for simple esophageal varicose veins,and tissue glue injection is recommended for gastric varicose veins.However,in the past,each center of GOVI type of esophageal and gastric varices chose therapy and sclerosing agent therapy according to their own conditions,but the efficacy was not definite,and there wan no evidence with high level of evidence based medicine.Therefore,this study mainly focused on patients with GOVI type of esophageal and gastric varices in liver cirrhosis,and retrospectively analyzed the efficacy of sequential treatment,sclerosing agent and simple ligation,and analyzed efficacy,mortality,hospitalization costs and total hospital stay of the two groups of patients with the two treatment methods.Method All patients with liver cirrhosis admitted to our hospital during 2018 were retrospectively collected,who were diagnosed as GOVI type of esophagogastric varices by endoscopic examination with a diameter of 1-2cm and were treated with endoscopic treatment.Record filtered to all hospitalized patients general data and clinical data,according to the treatment is divided into simple ligation sequential treatment group,sclerosing+tissue adhesive sequential injection group,respectively,compared two groups of patients basic information,Child score,MELD score,before and after endoscopic treatment of varicose vein diameter size,varicose veins,eliminating rate,postoperative adverse reactions,immediately stop bleeding rate and bleeding rate,6 weeks mortality,hospital total number and total length in hospital.Results Select those eligible for enrollment in our hospital in 2018 were GOVI type esophagogastric varices with varicose veins 1-2cm in length,A total of 45 patient were treated by sequential ligation alone,and 35 patients were treated by sequential injection of sclerosing agent combined with tissue glue(sclerosing agent combined with tissue glue,always asclerosing agent combined with tissue glue pure sclerosing agent or ligation).There were 64 males and 16 females.There were 54 cases of hepatitis b viral,8 cases of schistosomiasis,6 cases of alcoholic,5 cases of cryptogenic,3 cases of bile,2 cases of autoimmune,1 case of Wilson's disease and 1case of hepatitis c viral,.In the two groups of patients with liver function,the simple ligation group had the Aspartate transaminase 35.04±15.14U/L,the Alanine aminotransferase 24.80± 10.73U/L,and the tissue glue injection group had the Aspartate transaminase 64.29±151.74U/L(P < 0.05),and the Alanyl aminotransferase44.09 ±98.47U/L(P > 0.05).The diameter of varicose veins in the two groups were1.340 ±0.239cm(preoperative),0.540±0.163cm(postoperative),and tissue glue1.447±0.303cm(preoperative,P > 0.05),0.626±0.129cm(postoperative,P > 0.05).Follow-up 2-6 months,Varicose veins were completely eliminated in 1 cases in the simple ligation group and 2 cases in the tissue glue injection group.Among the postoperative adverse reactions,1 case of high fever,7 cases of low fever,4 cases of nausea,acid regurgitation and belching,and 1 case of upper abdominal discomfort were found in the simple ligation group.In the injection group,there were 4 cases of low fever,3 cases of nausea,acid regurgitation and belching,5 cases of upper abdominal discomfort,and 1 case of chest tightness.Postoperative hospitalization observation 2-3 days after the improvement.Postoperative follow-up;Ten cases were lost to the ligation group.No varicose vein was found in gastroscope reexamination 2months after surgery in 1 patient,and no varicose vein was found in gastroscope reexamination 7 months after surgery in 1 patient.One case of early bleeding(small amount of black stool);There were 2 cases of delayed bleeding(1 case for a small amount of blood stool,1 case for a small amount of black stool).Seven patients were lost to the injection group.No varicose veins were observed in gastroscope reexamination 1 case 1 month after surgery,and no varicose veins were observed in gastroscope reexamination 4 months after surgery in 1 case.There were 5 cases of early onset hemorrhage(2 cases were hematoplegia for 1 day,1 case was vomiting dark red blood with a small amount,1 case was black stool for 2 times,and 1 case was dark red blood stool for 1 time).Delayed hemorrhage occurred in 3 patients(1patient presented a small amount of hematemesis and black stool,1 patient presented1 case of coffee-vomiting blood and 1 patient presented 2 cases of hematemesis).The total number of hospitalization was 3.20±0.73 times in the simple ligation group and3.68±1.25 times in the injection group,and the difference was statistically significant(P < 0.05).The total length of hospitalization in the two groups was 15.82±7.06 days in the simple ligation group and 17.80±8.26 days in the injection group,and the difference was not statistically significant(P > 0.05).There were no deaths in the groups after 6 weeks of follow-up.Conclusions The two treatment methods(simple ligation group and injection group)can alleviate the degree of varicose veins and reduce the risk of bleeding,and the difference in improving the diameter of varicose veins is not statistically significant(P > 0.05).After the operation,adverse reactions occurred to varying degrees,all of which were mild without serious adverse reactions.The number of hospitalization in the simple ligation group was less than that in the injection group,and there was a significant difference(P < 0.05).There was no significant difference in the total length of hospitalization(P > 0.05). |
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