Analysis On The Influencing Factors Of Early Rebleeding After Endoscopic Improved Sandwich Method In Patients With Severe Esophageal Varices

Objective:The incidence of cirrhosis in China is very high,it accounts for 51.07% of people hospitalized for liver disease,esophageal varices(EV)is a common complication of decompensated cirrhosis,due to increased portal pressure,blood reflux,collateral circulation open,leading to increased varicose blood flow in the esophageal and gastric veins.The incidence and early rebleeding rate of esophageal varices bleeding(EVB)are high,so the treatment of bleeding and prevention of rebleeding is the top priority of clinical work.Severe EV is more critical and the risk of rebleeding is higher,so controlling bleeding quickly and effectively is an important part to saving and prolonging patients' lives.In recent years,endoscopic sandwich injection of Histoacryl and lauromacrogol has begun to be applied to EVB,Histoacryl can quickly solidify after contact with blood and block blood vessels,lauromacrogol can cause inflammation and cause blood vessels to disappear,both combined injection can stop bleeding quickly and reduce the incidence of rebleeding,the effect is remarkable.To explore the influencing factors of early rebleeding after endoscopic injection of Histoacryl and lauromacrogol for severe esophageal varices(EV)in this article,so as to take early measures to actively prevent and to improve the prognosis of patients.Methods:Clinical data of 89 patients with severe EV bleeding from the First Central Hospital of Baoding City between May 2016 to March 2018 were collected and incorporated,all patients were treated with Histoacryl and lauromacrogol sandwich method for the first time,and were divided into the non-bleeding group and the re-bleeding group according to the rebleeding within 6 weeks after operation.First,the univariate analysis was carried out to obtain indicators with significant differences,and binary unconditional Logistic regression analysis was included to obtain the independent risk factors affecting early rebleeding after severe esophageal variceal hemorrhage treated by Histoacryl combined with lauromacrogol.The ROC analysis was performed on the meaningful measurement data in the univariate analysis,and the optimal critical value was calculated.The area under the curve(AUC)was used to evaluate the value of the indicator.The difference was statistically significant at P < 0.05.Results:1.A total of 89 patients were included in the study for clinical follow-up,There were 17 cases of early rebleeding,72 cases of no rebleeding,and the rate of early rebleeding was 19.10%(17/89),one of which died from rebleeding.2.Univariate analysis showed: gender,age,cirrhosis etiology,primary liver cancer,portal hypertensive gastropathy,combined disease(hypertension,diabetes,coronary heart disease),total bilirubin,alanine aminotransferase(ALT),aspartate aminotransferase(AST),prothrombin time(PT),thrombin time(TT),prothrombin activity(PTA),international normalized ratio(INR),blood sodium,blood calcium,creatinine,blood glucose,white blood cell,platelet,hemoglobin,number of varicose veins,whether to treat gastric varices,amount of Histoacryl and lauromacrogol,Child-Pugh classification,FIB-4 index in the rebleeding group and the non-bleeding group were no significant difference(P>0.05).Ascites,red-color sign,endoscopic treatment one more time,portal vein embolization,albumin,internal diameter of main portal vein,AIMS65 score between groups had significant differences(P < 0.05),The P values were 0.043,0.006,0.041,0.036,0.011,0.014,and 0.007,respectively.3.Logistic regression analysis showed that internal diameter of main portal vein,portal vein embolization,red-color sign and albumin were the risk factors for early rebleeding of severe EV after the treatment of Histoacryl combined with lauromacrogol,the regression coefficients were 1.673,2.184,2.425,-3.751,the P values were 0.043,0.043,0.025,0.019,and the OR values were 5.327,8.882,11.306,0.023.4.The optimal critical value for albumin and internal diameter of main portal vein were 29.8 g/L,1.45 cm,the area under the curve for albumin and internal diameter of main portal vein were 0.702,0.700.Conclusion:1.Ascites,AIMS65 score and endoscopic treatment one more time were risk factors for early rebleeding after treatment of Histoacryl and lauromacrogol for severe EV.2.Internal diameter of main portal vein widened,portal vein embolization,red-color sign were the risk factors for early rebleeding of severe EV after the treatment of Histoacryl combined with lauromacrogol,albumin elevation was a protective factor for early rebleeding.