Application Of Doppler Ultrasound Combined With Elastography In The Evaluation Of Esophageal Variceal Bleeding In Cirrhosis

Objective: To explore the evaluation effect and correlation of portal hemodynamics measured by color Doppler ultrasound combined with elastography in patients with esophageal variceal bleeding due to cirrhosis.Methods: 94 patients with esophageal varices due to cirrhosis from January 2020 to December 2021 were selected as the observation group;After admission,relevant examinations and gastroscopies were completed to assess the patients’ physical condition.According to whether esophageal varices bleeding occurred,the patients were divided into bleeding group(n=38 cases)and non-bleeding group(n=56 cases);According to the degree of varicosity and bleeding,they were divided into mild group(n=36 cases),moderate group(n=31 cases)and severe group(n=27 cases);71 patients with physical examination in the same period were selected as the control group.After admission,all groups were examined by color Doppler ultrasound to determine the portal vein diameter(PVD),mean portal vein velocity(PVVmean),portal vein blood flow(PVQ),portal vein congestion index(CI)and liver stiffness measurement(LSM).The difference between hemodynamic level of portal system and LSM in the control group,observation group and subgroups of observation group were compared;Draw ROC curve,analyze the evaluation efficiency of LSM and the hemodynamic parameters of portal vein system measured by color Doppler ultrasound in patients with esophageal variceal bleeding due to cirrhosis;SPSS Pearson correlation analysis software was used to analyze the correlation between the level of portal hemodynamics and LSM in the incidence of esophageal variceal bleeding in cirrhosis.Results:(1)The levels of LSM and PVD,PVQ and CI in the hemodynamics of portal vein system in patients with liver cirrhosis in the observation group were higher than those in the control group(P<0.05);The level of PVVmean was lower than that of the control group(P<0.05);(2)There were 38 cases of esophageal variceal bleeding in 94 patients with cirrhosis,the incidence was 40.43%.The levels of LSM and PVD,PVQ and CI in the hemodynamics of portal vein system in patients with bleeding group were higher than those in the non-bleeding group(P<0.05);The level of PVVmean was lower than that of non-bleeding group(P<0.05);(3)According to the degree of varicose veins and bleeding,they were divided into three groups: mild,moderate and severe,and the ultrasonic measurement of patients was completed.The results showed that the levels of LSM and PVD,PVQ and CI in the hemodynamics of portal vein system in severe group were higher than those in mild group and moderate group(P<0.05);The level of PVVmean was lower than that of mild group and moderate group(P<0.05);The levels of LSM and PVD,PVQ and CI in the hemodynamics of portal vein system in moderate group were higher than those in mild group(P<0.05);The level of PVVmean was lower than that of mild group(P<0.05);(4)The results of ROC curve showed that the sensitivity and specificity of the combined determination of PVD,PVQ,CI,PVVmean and LSM in patients with esophageal variceal bleeding due to cirrhosis were higher than those of PVD,PVQ,CI,PVVmean and LSM alone(P<0.05);(5)The results of SPSS Pearson correlation analysis showed that the incidence of esophageal variceal bleeding in cirrhosis was positively correlated with the levels of PVD,PVQ,CI and LSM(P<0.05);There was a negative correlation with PVVmean level(P<0.05).Conclusion:(1)Color Doppler ultrasound combined with ultrasonic elastography can sensitively reflect the liver stiffness and hemodynamic level in patients with cirrhosis with portal hypertension;(2)The changes of liver stiffness and portal hemodynamics were related to the degree of esophageal varices and the incidence of variceal bleeding in cirrhosis;(3)The combined determination of different indicators can effectively assess the risk of esophageal variceal bleeding in cirrhosis,and can obtain high sensitivity and specificity.