| Objective: To observe the effect of diabetes on rebleeding after endoscopic treatment in patients with cirrhosis;Compare the efficacy of two treatments for sclerotherapy in the treatment of esophageal residual varices,which is less points big doses and multiple points small doses;Compare the efficacy of cut-off ligation and sclerotherapy in the treatment of Lesmi,D1.5 esophageal varices.Methods:(1)A retrospective analysis of patients who underwent endoscopic variceal ligation(EVL)or endoscopic injection sclerotherapy(EIS)in the First Affiliated Hospital of Anhui Medical University from June 2015 to March 2018 was conducted.The patients were divided into the EVL group and EIS group,and each group was subdivided into the diabetic group and non-diabetic group.Postoperative rebleeding rate was compared between the EVL and EIS groups and between diabetic and non-diabetic patients as well.The postoperative rebleeding rate in diabetic patients with hepatogenic and non-hepatogenic diabetes,and in patients with different liver function grades were also compared.(2)A retrospective analysis of patients who underwent sclerotherapy in the First Affiliated Hospital of Anhui Medical University from 2015.11-2018.9,divided into less points big doses group and multiple points small doses group.The average number of treatments,the average length of hospital stay,the rate of disappearance of varicose veins,the effective rate of sclerotherapy,the rate of emergency hemostasis,the rate of early rebleeding,the rate of delayed rebleeding,and the incidence of complications were compared between the two groups.(3)Retrospective analysis of patients with Lesmi,D1.5 esophageal varices treated with cut-off ligation and sclerotherapy in the First Affiliated Hospital of Anhui Medical University and Fuyang Hospital of Anhui Medical University from 2017.11-2019.2,divided into cut-off ligation group and sclerotherapy group.The disappearance rate of varicose veins,the rate of treatment efficiency,the rate of emergency hemostasis,the rate of early rebleeding,the rate of delayed rebleeding,and the incidence of complications were compared between the two groups.The cut-off ligation method is to continuously ligate blood vessels that are large and cannot be completely ligated at one time,with a "> or <" type at 3 points of the "left-right-left" of the blood vessel to completely block the blood vessel.Results:(1)In the total patient group,the rebleeding rate in the EVL group(11.3%,16.5%,23.5%)was not significantly different compared with that in the EIS group(9.8%,17.4%,29.3%)at 1,3,and 6 months after surgery,respectively(c2=0.125,0.028,0.913;P>0.05).In the total diabetic group,the rebleeding rate in the EVL group(25%,36.1%,44.4%)was not significantly different compared with that in the EIS group(20.6%,32.4%,47.1%)at 1,3,and 6 months after surgery,respectively(c2=0.193,0.11,0.048;P>0.05).In the EVL group,the rebleeding rate in the diabetic group was higher than that in the non-diabetic group(5.1%,7.6%,13.9%)at 1,3,and 6 months after surgery,respectively,and the difference was statistically significant(c2=7.916,14.581,12.822;P<0.05).In the EIS group,the rebleeding rate in the diabetic group was higher than that in the non-diabetic group(3.4%,8.6%,19%)at 1,3,and 6 months after surgery,respectively,and the difference was statistically significant(c2=5.325,8.403,8.159;P<0.05).After controlling for age and liver function grade in the EVL group and EIS group using binary logistic regression,diabetes was still a risk factor for postoperative rebleeding(P<0.05).There was no significant difference in the rate of rebleeding between patients with hepatogenic diabetes and non-hepatogenic diabetes at1,3,and 6 months after surgery,respectively(c2=0.227,0.123,0.580;P>0.05).In the total diabetic group,the rebleeding rate in the Child-Pugh A group(14.3%,17.9%,25%)was lower than that in the Child-Pugh B+C group(28.6%,45.2%,59.5%)at 1,3,and 6months after surgery,respectively.There was no significant difference between the two groups in the first month(c2=1.944;P>0.05)after surgery;however,the difference was statistically significant at 3 and 6 months after surgery(c2=5.590,8.069;P<0.05).(2)In the less points big doses group,the average number of injection points(2.73±1.01)and the average amount of sclerosing agent(20.61±7.69)ml,in the multiple points small doses group,the average number of injection points(5.78±1.01)and the average amount of sclerosing agent(11.33±6.35)ml.In terms of the average number of treatments,less points big doses group(2.74±0.81)was less than multiple points small doses group(3.22 ± 0.91)and the difference was statistically significant(t=2.599,P<0.05).The average length of hospital stay: less points big doses group(7.44±2.27)days,multiple points small doses group(7.66 ± 1.97)days,the difference was not statistically significant(t=0.466,P>0.05).The disappearance rate of variceal in less points big doses group was 46.8%,and in multiple points small doses group was 37.5%,the difference was not statistically significant(c2=0.738,P>0.05).The effective rate of sclerotherapy in less points big doses group(87.1%)was higher than that in multiple points small doses group(68.8%),and the difference was statistically significant(c2=4.589,P<0.05).The emergency hemostasis rate in both groups was 100%.The rates of early rebleeding and delayed rebleeding in less points big doses group and multiple points small doses group were(4.8% vs 3.1%,17.7% vs 18.8%),respectively,and the differences were not statistically significant(c2=0.000?0.014,P>0.05).The incidence of complications in less points big doses group and multiple points small doses group was(16.1% vs 12.5%),and the difference was not statistically significant(c2=0.026,P>0.05).(3)The disappearance rate of varicose veins:the cut-off ligation group(58.7%)was higher than the sclerotherapy group(37.3%)and the difference was statistically significant(c2=4.759,P<0.05).The rate of treatment efficiency:the total effective rate of the cut-off ligation group(93.5%)was higher than that of the sclerotherapy group(78.0%)and the difference was statistically significant(c2=4.815,P<0.05).The emergency hemostasis rate in both groups was 100%.The rate of early rebleeding:the cut-off ligation group and the sclerotherapy group were 4.3% and 3.4%,respectively,and the difference was not statistically significant(c2=0.000,P>0.05).The rate of delayed rebleeding:the cut-off ligation group and the sclerotherapy group were 4.3%and 11.9%,respectively,and the difference was not statistically significant(c2=1.028,P > 0.05).The incidence of complications in the cut-off ligation group and the sclerotherapy group were 8.7% and 13.6%,respectively,and the difference was not statistically significant(c2=0.604,P>0.05).Conclusions:(1)Diabetes is a risk factor for postoperative rebleeding in patients with cirrhosis.Diabetic patients with poor liver function are more likely to bleed after surgery and there was no difference in the postoperative bleeding rate between patients with hepatogenic and non-hepatogenic diabetes.(2)For the esophageal residual varicose veins,less points big doses sclerotherapy injection method is more effective than multiple points small doses sclerotherapy.(3)For large and distorted esophageal varices,the effect of cut-off ligation is better than that of sclerotherapy. |
PDF Full Text Request