The Results Of Endoscopic Variceal Ligation Of Esophageal Varices And The Effect On Haemodynamics Of Portal Systom

Objective:To evaluate the efficacy of endoscopic variceal ligation(EVL) for the treatment of esophageal varices and to observe the haemodynamical changes of portal system before and after the treatment.Methods:26 patients with liver cirrhosis and esophageal varices were treated by endoscopic variceal ligation.(1)To observe the efficiency of EVL including the rate of immediate hemostasis,the rate of bleeding recrudescence and the changes of esophageal variceal.(2)To measure the dynamical changes of portal vein and its branch veins before and after EVL including the inside diameter and blood flow velocity of portal vein,spleen vein,and left gastric vein.(3)To measure the plasma level of glucagon by the method of radioimmunoassay before and after EVL.Results:(1) The successful immediate hemostasis rate of variceal ligation was 93.75%.14-20 days latter,the eradicated and diminished rate of esophageal varices was 88.46%.During 6 months there are 3 ptients bleeding again,and the rebleeding rate was 11.54%.(2) Portal vein and spleen vein in 26 patients were detected befor and after endoscopic treatmen(100%),The inside diameter of portal vein and spleen vein had no significant changes(portal vein:13.33±1.74mm vs 13.41±1.50mm.P>0.05;spleen vein:10.57±2.97 vs 10.64±2.85 , P>0.05) , but their blood flow velocity increased significantly (potal vein:24.5±4.35 cm/s vs 27.44±6.54cm/s,P<0.05;spleen vein:28.6±5.65cm/s vs 31.47±7.21cm/s,P<0.05).Left gastic vein was discovered in 24 patients(88.5%).The inside diameter and blood flow velocity of left gastric vein had no significant changes.But the blood flow direction had significant change after EVL.20 patients(87%) showed hepatofugal flow,2 patients(8.7%)bi-directional flow,and 1 patient(4.3%)hepatopetal flow before the treatment,while 15 patients(65.2%)showed hepatopetal flow,5 patients(20%) showed hepatofugal flow,and 3 patients(13.0%) bi-directional flow after treatment(P<0.01).(3) The plasma level of glucagon had no significant change before and after EVL(195.71±50.9ng/L vs 218.7±79.6ng/L, P<0.05).Conclusions:(1)Endoscopic variceal ligation is an effective method to prevent and treat esophageal variceal bleeding.(2)The dynamical measurement indicates that endoscopic variceal ligation could increase the blood flow velocity of portal vein,spleen vein and change the direction of left gastric vein.(3) The plasma level of glucagon has no obscure change before and after endoscopic variceal ligation.