The Outcome And Risk Factors Of Early Rebleeding After Esophageal Variceal Ligation

Objective:Analyzing the effect of EVL in patients with cirrhosis,and exploring the risk factors of early rebleeding after EVL,so as to provide some prevention and improve patient prognosis.Methods:From January 1,2015 to January 1,2020,313 patients with cirrhosis who were hospitalized in the Department of Gastroenterology of the second hospital of Hebei Medical University and had complete case data were analyzed.Recording the general clinical data of patients and analyzing the total effective rate after EVL to record the treatment effect.According to whether rebleeding occurred within 6 weeks after surgery owing to esophageal variceal hemorrhage,patients can be divided into two groups: rebleeding group and non-bleeding group.Through spss25 software,statistical analysis of the differences between the two groups of patients’ clinical indicators.Subsequently,analyze the statistically significant indicators by Logistic multivariate regression and ROC curves,to discuss the risk factors of early rebleeding.Results:1.A total of 313 patients were enrolled,including 211 males and 102 females,with an average age of 52.79 ± 10.08.2.In this study,all patients were treated by internal medicine combined with EVL.After EVL treatment,the disappearance rate of esophageal varices was 14.7%,and the total effective rate was 265 cases(84.7%).3.There were 27 patients with early rebleeding after EVL and 286 patients without bleeding.The rate of early rebleeding was 8.6%.Among them,the bleeding was controlled in 21 patients after treatment again,3 patients were further treated with TIPS after treatment failure,and 4 patients died(the mortality was about 14.8%).4.The Child-pugh grade(P = 0.002),ascites(P = 0.008),Portal vein thrombosis(P = 0.018)、prothrombin time(P = 0.000),serum albumin(P = 0.009),hemoglobin(P = 0.016)、MELD(P = 0.033)、esophageal varices(P = 0.004),with gastric varices(P = 0.005),number of ligation rings(P = 0.003),esophageal and gastric varices red sign(P = 0.009,P = 0.017)、whether to use somatostatin or propranolol(P = 0.044,P = 0.017)were statistically significant between the two groups(P < 0.05).5.The results of logistic regression analysis showed that there were significant differences in PT、massive ascites、Portal vein thrombosis、no propranolol、MELD、Child-pugh grade C.The prediction value of PT and MELD scores on early rebleeding was analyzed by ROC.The AUC under ROC was 0.877 and 0.610,the critical value was 16.9 and 10.5,the sensitivity was 87.1% and 77.4%,the specificity was 77.2% and 49.6%,respectively.Conclusions:1.The early rebleeding rate was 8.6%.2.Prothrombin time,massive ascites,portal vein thrombosis and no use of propranolol were independent risk factors of early rebleeding after EVL.PT and MELD scores can be used to predict the risk of early rebleeding.3.In order to reduce the rate of rebleeding,we should improve the liver function,prothrombin time and ascites before EVL operation,and apply the medicine of reducing portal pressure after EVL operation,such as propranolol.