| Background:Esophageal and gastric varices bleeding(EVB)caused by portal hypertension(PHT)is one of the most serious complications of liver cirrhosis,with a mortality rate of 30%-70%.The methods of secondary prevention of esophagogastric variceal bleedingin cirrhosis include oral propranolol(propranolol hydrochloride tablets),ligation or sclerosis of internal inferior vena cava,partial splenic embolization(PSE),transjugular intrahepatic portosystemic shunt(TIPS),surgery,etc.Each treatment method has its indications and advantages and disadvantages.Partial arterial embolization can significantly increase the number of white blood cells and platelets in peripheral blood and improve coagulation function.Based on this,this study collected patients with cirrhosis portal hypertension and severe esophagogastric varices diagnosed by the Department of Gastroenterology of our hospital,collected data and followed up according to the inclusion and exclusion criteria,and explored the efficacy of partial splenic embolization combined with propranolol in patients with severe esophagogastric varices,hoping to provide a reference for the treatment of patients with severe esophagogastric varices.Objective:To analyze the clinical efficacy of partial splenic embolization combined with propranolol in patients with severe esophagogastric varices,and the correlation between hemodynamics and upper gastrointestinal bleeding after treatment.Methods:In this study,60 patients with cirrhotic portal hypertension and severe esophageal and gastric varices(EGV)diagnosed by the Department of Gastroenterology of Foshan Sanshui District People’s Hospital were selected according to China’s endoscopic diagnostic criteria were divided into experimental group and control group according to the random number table method,30 cases in each group.The experimental group was treated with partial splenic artery embolization on the basis of propranolol treatment,and the control group was treated with propranolol tablets.Laboratory tests(blood routine,liver function)and color Doppler ultrasonography were performed before treatment and 1 week,1 month,half a year,1 year and 2 years after treatment.Hemoglobin content,white blood cell count,red blood cell count and platelet count were detected by blood routine examination.Alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were detected by liver function test.The internal diameter and maximum blood flow velocity of portal vein(PV),splenic vein(SV)and superior mesenteric vein(SMV)were detected by color Doppler ultrasonography,and the venous blood flow was calculated.The data and results of the experimental group and the control group were compared and analyzed to evaluate the overall efficacy and short-term and long-term efficacy of partial card embolization combined with propranolol in the treatment of severe esophageal and gastric varices.Observe and record whether the patients had gastrointestinal bleeding within 2 years after treatment,divide them into bleeding group and non-bleeding group,and perform logistic regression analysis to explore the correlation between hemodynamic indicators and bleeding events within 2 years after treatment.SPSS statistical software was used for statistical analysis of relevant data,and P<0.05 was considered statistically significant.Results:1.The total effective rate of the experimental group was 93.33%;the total effective rate of the control group was 63.33%.The total effective rate of the experimental group was higher than that of the control group(X~2=7.9542,P=0.0048).2.Comparison of short-term efficacy between the experimental group and the control group:Different degrees of complications occurred in both groups within 72hours after operation.There was no significant difference in the incidence of postoperative complications between the two groups(x~2=6.1040,P=0.2960>0.05)3.Comparison of long-term efficacy between the experimental group and the control group:The incidence of rebleeding included recent bleeding(rebleeding from 72 hours after treatment to the disappearance of varicose veins)and long-term bleeding(rebleeding from the disappearance of varicose veins to 2 years after treatment).There was no significant difference in the recent rebleeding rate between the two groups(X~2=0.1442,P=0.7041>0.05).There was significant difference in the long-term rebleeding rate between the two groups(X~2=11.8822,P=0.0006<0.05).4.Comparison of blood routine indexes between the experimental group and the control group:After treatment,the hemoglobin content,white blood cell and platelet counts in the experimental group were higher than those in the control group(P<0.05).There was no significant difference in red blood cell count between the two groups(P>0.05).5.Comparison of serum indexes of liver function between the experimental group and the control group:After 1 week,1 month,6 months,1 year and 2 years of treatment,the contents of ALT and AST in the experimental group were lower than those in the control group,and the differences were statistically significant(P<0.05).6.After 1 week,1 month,6 months,1 year and 2 years of treatment,the diameter of portal vein and splenic vein trunk in the experimental group was lower than that in the control group,and the difference was statistically significant(P<0.05).At each time point,there was no significant difference in the diameter of the main trunk of the superior mesenteric vein between the two groups(P>0.05).7.One week,one month,half a year,one year and two years after treatment,the maximum blood flow velocity of portal vein and splenic vein in the experimental group was lower than that in the control group,and the difference was statistically significant(P<0.05).At each time point,there was no significant difference in the maximum blood flow velocity of superior mesenteric vein between the two groups(P>0.05).8.One week,one month,half a year,one year and two years after treatment,the portal vein and splenic vein blood flow in the experimental group were lower than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in superior mesenteric venous blood flow between the two groups at each time point(P>0.05).9.After 2 years of follow-up,The results showed that the portal vein blood flow velocity,splenic vein blood flow velocity,portal vein diameter,splenic vein diameter,hemoglobin content and platelet count were compared between the bleeding group and the non-bleeding group.The difference was statistically significant(all P>0.05).10.The results of multivariate logistic regression analysis showed that portal vein blood flow velocity,splenic vein blood flow velocity,portal vein diameter and splenic vein diameter were independent risk factors for upper gastrointestinal bleeding in patients with severe esophagogastric varices within 2 years after treatment.Hemoglobin content and platelet count were independent protective factors.Conclusion:1.Partial splenic embolization combined with propranolol in the treatment of patients with severe esophagogastric varices has the advantages of high safety,definite hemostatic effect,low incidence of short-term and long-term rebleeding and few complications.2.Partial splenic embolization combined with propranolol in the treatment of patients with severe esophageal and gastric varices has little effect on the blood flow pressure of superior mesenteric vein,significantly improves portal vein and splenic vein hypertension,and can improve liver function and coagulation function.3.Portal vein blood flow velocity,splenic vein blood flow velocity,portal vein diameter and splenic vein diameter were positively correlated with upper gastrointestinal bleeding within 2 years after treatment in patients with severe esophageal and gastric varices,while hemoglobin content and platelet count were negatively correlated with it. |
PDF Full Text Request