Clinical Study On The Accurate Dissection Of Esophageal And Gastric Varices Under Gastroscopy

Background and purpose:Esophageal and gastric varices are the collateral circulation of portal hypertension and blood flow resistance due to various reasons.The most common reason is the portal hypertension caused by hepatitis b,alcoholic cirrhosis,primary biliary cirrhosis,hepatitis c,cryptogenic cirrhosis,autoimmune liver disease.In addition,idiopathic portal hypertension,non-cirrhotic portal vein thrombosis,buka syndrome are also common causes of portal hypertension esophageal varices.Due to no significant symptoms,patients early in our country medical project gastroscope is not popular,so early diagnosis and treatment to bring very great difficulty,when it comes to most of the patients were diagnosed by using gastroscopy is already late,can only through the application of hardener,adhesives,leather trap method of treatment,With the further deterioration of the etiology of liver cirrhosis,the degree of esophageal varices in the fundus of the stomach is also increasing,and the rupture of the varicose veins is easy to repeat.Severe gastric fundus esophageal varices significantly reduce the quality of life of patients,and the mortality of esophageal varicose rupture hemorrhage is very high,which is a common digestive system emergency.Current research experts in all countries of the world is constantly updated,fewer complications and lower recurrence rate of the treatment,common medical treatments include: endoscopic hardener injections(EIS),the treatment of varicose vein ligation under endoscope(EVL [1]),endoscopic tissue glue injection treatment,endoscopic ultrasonography(EUS)guided by endoscopic treatment,the argon ion coagulation technique,photodynamic therapy and so on.Studies have shown that most of the varicose veins rupture at the lower end of the esophagus 4-5cm,as there are a large number of esophageal and gastric wall perforating veins.Through clinical research,such as cao found for esophageal varicose vein and gastric varicose vein of patients with gastric varicose vein tissue glue injection precision traffic from broken stomach bottom coalition of esophageal varicose vein ligation or the treatment effect of hardening is better than that of pure sclerosis of esophageal varices ligation,hardening or ligation combined treatment.In recent years,with the continuous efforts of experts and scholars at home and abroad,the treatment of esophageal varicose veins in the stomach has been continuously innovated,and the treatment is more accurate and individualized.For example: Endoscopic esophageal gastric Varices precision block technique(Endoscopic Selective Varices Devascularization,ESVD)is the source of gastroesophageal Varices through precise selection,transportation branch,accurately plugging,thus not only achieve instant hemostasis,maximum to prevent bleeding at the same time,realize patients safe and healthy living a treatment for a long time.Based on the definition of ESVD gastroesophageal varices can be roughly divided into four types: I,venous reflux upward class: gastric coronary vein and splenic vein branch through the gastric mucosa or esophageal mucosa to internal migration to the esophagus,blood flow direction from bottom to top;II.Venous reflux descending type: gastric coronary vein or splenic vein branch passes through the gastric mucosa,and the blood flow direction is downward;IIi.Upstream and downstream of venous recirculation: the combination of ascending and descending classes;Iv.Vein reflux No-way: after splenic vein embolization or external compression,the internal venous drainage of the gastric mucosa is severely blocked,and there is nowhere to go to the shunt vein.According to these four different types of precise separation,there are four different ways.In this paper,the research aims to compare endoscopic esophageal gastric varices precision block with the traditional simple ligation operation,curing agent injection or ligation combined with hardener injection of the two treatments in efficient and prevention of further hemorrhage.Methods: to collect 2012-2017 Qingdao municipal hospital stomach at the end of 66 cases of patients with esophageal varices,33 patients with liver cirrhosis after hepatitis b,3 cases of autoimmune liver disease,12 cases hidden sources of cirrhosis and alcoholic liver cirrhosis 12 cases,4 cases of early primary biliary cirrhosis,liver cirrhosis after hepatitis c in 2 cases.According to the Sarin classification,these patients were divided into: GOV1 type(the varicose vein extends from the esophagus to the stomach or the cardia),and the GOV2 type(the varicose vein extends from the esophagus to the great bend of the stomach).Treatment the patient can be divided into two groups according to the use,including simple esophageal vein ligation or hardening treatment group of 36 cases of observation group,the bottom of the stomach esophagus varicosity precision cut-out operation treatment group 30 cases as control group,compared two groups of efficient(1 month after through telephone follow-up of patients quality of life have greatly improved and or review before qu zhangjing arteries and veins is gastroscope treatment decreased 20%-50% is valid)and bleeding rate,5 months.Using chi-square analysis method for testing the merits of the two methods of treatment,using logistic regression analysis method for classification of second inspection of gender,age,whether factors have an effect on the conclusion,in the process of data analysis,deleted and bleeding caused by liver cancer cases.All the statistical analyses were bilateral,and the difference between P<0.05 was considered statistically significant.Results: The effective rate of the observation group(accurate drainage)was 96.2%,higher than that of the control group(P= 0.047 p <0.05),and 27.8% of the control group(traditional simple ligation and sclerotherapy injection),higher than that of the observation group(P= 0.027 p <0.05).In the binary Logistic regression analysis,gender had no significant influence on the efficacy and recurrence of bleeding(95% CI,0.905-24.015).P=0.066),(95% CI,0.948-1.079);P=0.735),and age has no significant influence on whether it is effective and whether there is no rebleeding(95% CI,0.927-1.064).P=0.836),(95% CI,0.198-2.505);P = 0.588).Conclusion the accurate fracture of gastric esophageal varicose veins is better than that of the traditional treatment with simple ligation or hardening treatment.