The Risk Factors Of Esophageal Varices Bleeding And Postoperative Rebleeding In Patients With Portal Hypertension

Esophageal Varices Bleeding(EVB) is one of the most common and serious complication of portal hypertension. Approximately 30%-40% of decompensated cirrhosis patients have varicose veins, and the rate of esophageal varice in decompensated patients is approximately 60%. Once diagnosed with varicose veins, the incidence rate of varicose bleeding within two years is about 25%. even if the current best treatment, the mortality rate of variceal bleeding is still around 20%. So if we can accuratedly analysis and predict of esophageal varices bleeding risk factors and provide the effective treatment programs timely, mortality in patients with portal hypertension will be effectively reduced and the prognosis of patients will be improved. This study was designed to investigate the risk factors of variceal bleeding in patients with portal hypertension and provide the appropriate interventions to reduce the incidence of variceal bleeding. [objective]1. To explore and analyze the variceal bleeding risk factors in patients with portal hypertension.2. To explore and analyze the risk factors of gastrointestinal bleeding in patients with portal hypertension after surgical treatment.3.The differences between pericardial devascularization plus splenorenal shunt and devascularization were also evaluated. [methods]1.From January 2003 to December 2013, 496 patients with portal hypertension were treated surgically in Tang Du Hospital of the Fourth Military Medical University. According to history of the upper gastrointestinal variceal bleeding or not before admission, patients were subgrouped into the bleeding group(288 cases) and non-bleeding group(208 cases). 34 indicators of patients examined before admission were studied including the general information, laboratory tests, imaging records and so on.And the factor which has the statistically significant difference(P <0.05) was used for further non-conditional logistic regression analysis to obtain the independent risk factors of upper gastrointestinal bleeding.2.The follow-up survey was finished by telephone, clinics records and other methods.Follow-up deadline is July 30, 2014. In total,474 cases were followed up, 22 cases were lost in followed up(4.46%). And according to presence or absence of postoperative bleeding experience, patients were divided into bleeding group(58 cases) and non-bleeding group(220 cases). 39 indicators before surgery,such as the general condition of the patient, laboratory tests, impact studies, surgery condition were also reviewed. The groups univariate statistical analysis was used to analysis the statistical difference.And the factor which has the statistically significant difference(P <0.05) was used for non-conditional logistic regression analysis to obtain the independent factors affecting postoperative rebleeding.3.According to surgical procedures, patients who had history of bleeding were divided into two subgroups including devascularization plus splenorenal shunt group and pericardial devascularization group. Postoperative bleeding rates, survival status and postoperative complications are compared between the two groups.[Results]1. Univariate statistics analysis showed 12 indicators were statistically significant(P <0.05)between the bleeding group and non-bleeding group.The indicators were gender, the incidence of type, AST, ALT, TBIL, PLT, HGB, PT, portal vein, splenic vein diameter, esophageal varices, red sign. Logistc regression results show that these indicators such as Esophageal varices, portal vein diameter, platelet count, hemoglobin and prothrombin time are independent risk factor S for variceal bleeding in patients with portal hypertension.2. 10 indicators were found to be statistically significant(P <0.05) between the bleeding group and non-bleeding group.The indicators were Child-pugh grade, Meld score, surgical approach, use laparoscopy or not, AST, PT, PTA, FIB, indocyanine green retention rate of 15 minutes(ICG-R15), EHBF.Logistc regression results show that these four indicators such as choice of surgical approach, laparoscopic use, PT, EHBF are independent gastrointestinal bleeding risk factors in patients with portal hypertension after surgical treatment.3. Patients received pericardial devascularization plus splenorenal shunt: the rebleeding rate within one year is 2.4%, rebleeding rate within there years is 5.4%, the rebleeding rate within five years is 9.9%. Patients with pericardial devascularization: the rebleeding rate within one year is 9.5%, rebleeding rate within there years is 19.2%, the bleeding rate within five years is 33.1%. Patients received pericardial devascularization plus splenorenal shunt: the survival rate within one year is 97.3%, survival rate within there years is 95%, the survival rate within five years is 88%. Patients with pericardial devascularization: the survival rate within one year is 91.7%, survival rate within there years is 89.4%, the survival rate within five years is 79.3%. The bleeding rate and survival rate by Log-Rank test are significantly different(P <0.05) between two groups. The incidence of hepatic encephalopathy and portal vein thrombosis rate after Surgical treatment by Chi-square test were no significantly different(P> 0.05). [Conclusion]1. Esophageal varices, portal vein diameter, platelet count,the time of hemoglobin and prothrombin are independent risk factors of esophageal bleeding in patients with portal hypertension.2. The choice of surgical approach, laparoscopic use, PT, EHBF are independent gastrointestinal bleeding risk factors in patients with portal hypertension after surgical treatment.3.The pericardial devascularization plus splenorenal shunt are better than devascularization in reducing gastrointestinal bleeding rates and improving survival rates.