The Guiding Effect Of Multi-slice Spiral CT On The Treatment Of Gastric Varicose Vein Tissue Glue

BACKGROUND: Gastroesophageal varices(GEVs)are a common complication of liver cirrhosis.About 50% of patients with liver cirrhosis have gastroesophageal varices and about 22%-25% of patients with liver cirrhosis have gastric varices.Because of the simple and non-invasive operation of CT examination,it is more and more widely used in the diagnosis and treatment of gastroesophageal varices.AIM: This study was performed to investigate the guiding effect of multi-slice spiral CT on the treatment of gastric varicose vein tissue glue.METHODS: A retrospective study was conducted on 362 patients who received tissue glue injection treatment in the Second Affiliated Hospital of Chongqing Medical University from November 2013 to April2019,which were divided into the MSCT group and the control group.The endoscopic classification and MSCT images of gastric varices in the MSCT group were observed,and the results of the two typing were analyzed by the Kappa consistency test.Patients in the MSCT group were determined the shape,inflow and outflow of gastric varicose veins,and the startingpoint of the inflow path is selected as the injection point.The control group chose the conventional injection site which is the most uplifting point of the swelling of the gastroscopic varicose veins.The SPSS 23.0 was used for statistical analysis to compare the rate of rebleeding and the incidence of ectopic embolism in the MSCT group and the control group.RESULTS: The gastroscopic classification of gastric varicose veins was in good agreement with MSCT images(Kappa=0.830,p<0.05).The overall rate of postoperative rebleeding in 362 patients with gastric fundus tissue glue injection treatment was 21.8%(79/362),and the rate of rebleeding from varicose gastric veins was 12.1%(44/362).The overall rate of postoperative rebleeding and the rate of gastric varicose rupture rebleeding in the MSCT group were 11.8%(10/85)and 5.9%(5/85),respectively,which are lower than the rate of the control group(24.9%(69/277)and 14.1%(39/277)(p<0.05).Subgroup analysis found that although the rate of rebleeding in the MSCT group within 1 month,3months and 6 months(1.2%,5.9%,7.1%,respectively)was not statistically significant compared with the statistics of the control group(2.5%,6.9%and 12.6%,within 1 month,3 months and 6 months)(p>0.05).However,the rate of re-bleeding in the MSCT group within 12 months(10.6%)and 1year later(11.8%)was lower than that of the control group(20.6% and24.9%)(p<0.05).The median amount of tissue glue in both the MSCT group and the control group was 2ml,with no statistically significantdifference(p>0.05).No postoperative ectopic embolism was observed in the MSCT group and the control group.During follow-up,patients with gastric varices rebleeding were found to have unoccluded gastric fundus vascular shadow upon MSCT reexamination.CONCLUSION: The classification of gastroesophageal varices accessed by MSCT was consistent with the classification under gastroscope.MSCT examination before treatment can identify the inflow and outflow channels of gastric varicose veins,guide the injection site of tissue glue,and reduce the long-term overall rate of rebleeding and the rate of gastric varicose rupture rebleeding.During follow-up,the presence of non-occluded blood vessels in the gastric fundus detected by MSCT examination may lead to recurrent bleeding.