| Objective: To retrospectively analyzed the clinical data of cirrhotic patients with esophagogastric varices(GOV)treated in Jiaxing first Hospital,and to evaluate the incidence of portal hypertensive gastropathy(PHG),and to explore the efficacy of endoscopic treatment,laparoscopic splenectomy plus pericardial devascularization(LSPD)and double endoscopy in the treatment of cirrhotic GOV and its influence on PHG.Methods: Data of patients with cirrhotic GOV who underwent endoscopic or(and)LSPD in the Department of Gastroenterology of Jiaxing First Hospital from January 1,2018 to October 31,2022 were collected,including gender,age,etiology,laboratory examination,imaging examination and endoscopic image data.The patients were divided into endoscopic group,laparoscopic group and double-endoscopic group according to the treatment they had received.Liver function was graded according to Child-Pugh score.The curative effect of GOV was evaluated according to the degree of improvement of dangerous varicose veins.PHG was graded according to Mc Cormack 2score.The incidence of PHG was evaluated during follow-up.The general data,curative effect of GOV,blood index before and after operation,PHG,postoperative rebleeding and complications were compared and analyzed among the three groups.All data were analyzed by SPSS 26.0 software.Results: In this study,30 patients were excluded and finally included in 256 GOV patients with liver cirrhosis and portal hypertension,including 171(66.8%)males and85(33.2%)females,with an average age of(62.0 ± 10.6)years.There are 125 cases in the endoscopic group,75 cases in the laparoscopic group,and 56 cases in the double-endoscopic group.A total of 154 patients were diagnosed with PHG of cirrhosis,and the incidence of PHG was 60.2%.There were no significant differences in gender,age and etiology among the three groups(P > 0.05).There were 76(60.3%)cases of PHG in Child A,71(60.7%)cases of PHG in Child B and 7(53.8%)cases of PHG in Child C.There was no significant difference in the incidence of PHG among different Child grades(P = 0.928).Hemoglobin and albumin in the endoscopic group were lower than those in the laparoscopic and double-endoscopic groups,but the difference was statistically significant only between the endoscopic and laparoscopic groups(P <0.001).The white blood cell count,hemoglobin,platelet count,total bilirubin,serum creatinine,blood urea nitrogen,prothrombin time and international standardized ratio indexes of the two groups were better than those of the endoscopic group after surgery,with statistical significance(P < 0.001).The improvement of PHG and esophagogastric varices in the double-endoscopic group was significantly better than that in the endoscopic group and the laparoscopic group,with statistical significance(P< 0.001).There was no significant difference between endoscopic group and laparoscopy group(P > 0.05).PHG was significantly improved in the double-endoscopic group,and partially aggravated in the endoscopic group,with statistical significance(P < 0.001).There were 2 cases of recurrent bleeding in endoscopic group,1 case in laparoscopic group and 1 case in double endoscopic group.There were respectively 15,12 and 12 cases of complications.There was no death in all three groups.There was no significant difference in postoperative rebleeding,complications and mortality among the three groups(P > 0.05).Conclusion: The incidence of PHG in liver cirrhosis was 60.2% in this study.There was no significant difference in the incidence of PHG among patients with different Child grade.The endoscopy combined with laparoscopy has the best effect in the treatment of liver cirrhosis GOV and can improve the PHG of liver cirrhosis.Patients with Child C and acute variceal bleeding are suitable for gastroscopic treatment,but PHG is at risk of aggravation.Double endoscopy and laparoscopy can significantly improve blood coagulation and renal function,and relieve hypersplenism in cirrhotic patients with GOV. |
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