The Curative Effects About The Secondary Prevention Of The Esophageal Variceal Bleeding(EVB)

Objective:Comparing the effect comparison between sclerotherapy and surgical treatment to the Cirrhosis of the liver ruptured esophageal varices bleeding,thus we can provide the guiding way about the treatment for those EVB patients,and improve the level of clinical diagnosis and treatment.Methods:Collecting 228 cases of liver cirrhosis patients with esophageal varices bleeding.In the fujian province hospital from January 1,2010 to January 1,2016,8cases died in the hospital time,31 cases lost to following up and 20 cases were excluded for the diagnosis of primary liver cancer,18 cases treated through the endoscopic and the surgery,35 cases were treated through laparoscopic use.Finally 78 cases were qulified liver cirrhosis patients with esophageal varices bleeding.After the initial hemostasis treatment,we divided those patients into three groups according to the treatment: the patients by using the endoscopic injection sclerotherapy was totally21 cases(The endoscopic treatment group),the patients by using the treatment of surgery of splenectomy in combination with cardiac peripheral vascular was totally 35cases(The surgery group),the patients by using TIPS operation was totally 21 cases(The TIPS group).Compared the difference of hospitalized days,short-term hemorrhage rate(one month),6 months and bleeding rate,1 year and bleeding rate,preoperative and postoperative liver function(6 months)change,change of the changes of the white blood cells,platelets,complications,the cost and mortality between the two group.Results:There was no statistically significant difference in hospital days postoperatively in patients between the three groups,although the postoperative hospitalization daysin general surgical group was slightly higher than the days in endoscopic treatment group.The rates of postoperative liver function in surgical group was obviously improved compared with the rates before operation(P < 0.05),while the albumin values and prothrombin time was significant difference compared with the preoperative elevated obviously,there was statistically significant,but the values of the total bilirubin was no significant difference compared with the values before operation,and the rates of postoperative liver function in TIPS group was even worse compared with the rates before operation,;The prothrombin time in endoscopic treatment group was reduced slightly compared with the preoperative,but the significant was difference,there was statistical significance,and the values about albumin and total bilirubin were no significant differences compared with the preoperatives.The values of white blood cells and platelets in the patients of surgical group were statistically significance compared with the values of preoperative,while the values of endoscopic treatment group were no significant difference,and the values of platelets in patients of TIPS group were statistically significance compared with the values before the treatment.There was significant difference in the rate of rebleeding(one year and more than one year)between the surgical group and endoscopic treatment,while the rate of rebleeding(one month and six month)was no significant difference.There was significant difference in the rate of rebleeding(one year and more than one year)between the TIPS group and endoscopic treatment,while the rate of rebleeding(one month and six month)was no significant difference.The incidence of complications in endoscopic treatment group was 42.9%,and the surgical group was 91.4%.The incidence rate of surgical group was higher than those of endoscopic treatment group.There was significant difference in complication rate between the two groups.But the incidence rate of TIPS group was the highest,which was 100%.The majority complications of endoscopic treatment group was early bleeding,accounted for 55.6%,while the majority complications of surgery group was postoperative fever,accounted for 37.5%,and the type of complications in surgery group was more than endoscopic treatment group.The majority complications of TIPS group was gingival bleeding.The cost in the TIPSgroup was more than that in the other groups(P < 0.05),but the cost between the endoscopic group and the surgical group was no significant difference.The totally cost in the TIPS group was higer than that in the surgical group,(P<0.05).There were no significant difference of the mortality rate(within one year and more than one year)between the three groups.Conclusion:(1)The postoperative liver function of the surgical group was obviously improved,which albumin increased significantly,and the values of postoperative PT in endoscopic treatment group was decreased obviously,but the others indicators were no significant improvement.The postoperative liver function of the TIPS group was even worse.(2)The values of postoperative leukocyte was rebounded significantly in surgical group,while the values of platelet has risen to normal state.(3)The rate of rebleeding(one year and more than one year)in surgical group was significantly lower than the rate in endoscopic treatment group,but the incidence rate of surgical group is higher.The rate of rebleeding(one year and more than one year)in TIPS group was significantly lower than the rate in endoscopic treatment group,but the incidence rate of surgical group is higher.(4)The cost and totally cost in the TIPS group were the higest,and the cost between the endoscipic treatment group and surgical group was no significant difference.(5)There were no significant difference of the mortality rate between the three groups...