Comparisons Of Treatment Options For Cirrhosis With Upper Gastrointestinal Bleeding Caused By Portal Hypertension

Portal hypertension of liver cirrhosis is caused by various reasons(such as hepatitis virus,alcohol,drugs,fatty liver,immune diseases),and when liver cirrhosis develops to late stage and portal vein pressure increases.The appearance of portal hypertension often indicates the terminal stage of the development of various chronic liver diseases.The main manifestations is opening of collateral circulation,splenomegaly,ascites,and often accompanied by esophagogastric varices bleeding.Portal hypertension and upper gastrointestinal bleeding often lead to anemia and hemorrhagic shock in patients,which may increase liver cell damage,induce hepatic encephalopathy,threaten patient’s life,and cause esophagogastric varices bleeding(EGVB)becomes the most serious complication of cirrhosis.The upper gastrointestinal bleeding caused by portal hypertension in liver cirrhosis is a common disease in the digestive department,accounting for about20% of patients with upper gastrointestinal bleeding.Its clinical features are fierce hemorrhage,large amount of bleeding,high mortality rate of first hemorrhage,and high rate of rebleeding after various treatments,and each hemorrhage can make liver function worsen,with many andsevere complications.The mortality rate is high and there is still a lack of effective preventive treatment.At present,the upper gastrointestinal bleeding caused by portal hypertension in liver cirrhosis is still dominated by traditional prevention and treatment.Including drug therapy,endoscopic treatment,surgical treatment(splenectomy and cardivascular detachment surgery).Objective:To explore the therapeutic effect of cirrhosis with upper gastrointestinal bleeding caused by portal hypertension and by the following three different treatments:the surgical operation(splenectomy and pericardial vascular disconnection),endoscopic treatment and drug treatment,offering scientific evidences for clinical treatment to the liver cirrhosis bleeding.Materials and methods:A retrospective analysis of 417 patients with cirrhosis and portal esophagogastric variceal bleeding hospitalized in Hepatobiliary and Pancreatic Department of First Hospital of Jilin University from June2011 to September 2017 was performed.244 patients with severe cardiopulmonary diseases and important organ diseases,space-occupying lesions and incomplete data were excluded.Finally,173 patients were included in the study.(1)The selected patients may have 1-3 bleeding history before admission.After initial hemostasis,thepatients were divided into medication group(102 cases),endoscopic group(40 cases),surgical group(31 cases)Cases),access to collect the patients serology and imaging data,each group according to liver function Child-Pugh grading,compared the rate of rebleeding and mortality in 6 months,1 years,and 2 years after the treatment of the three methods.(2)Collected the portal vein diameter examined by color Doppler ultrasound,then divided into portal vein diameter <13mm group(24 cases);portal vein diameter 13 ~ 15 mm group(21 cases);portal vein diameter> 15 mm group(20 cases).The degree and shape and color of esophageal varices under the microscope were divided into3 groups: mild,moderate and severe.Statistical analysis was done by SPSS software to determine the relationship between portal vein diameter,rebleeding time and esophageal varices.Results:(1)There were significant differences in the rate of rebleeding between the three groups of drug treatment group,endoscopic treatment group and surgical operation group at 6 months,1 year and 2 years(P<0.05),including that the rate of rebleeding within 6 months,1 year,2years was significantly lower in the surgical group than in the drug treatment group(P<0.02),and the rate of rebleeding within 2 years was significantly lower than that of the endoscopic treatment group(P <0.02).However,the rate of rebleeding within 1 year and 2 years wassignificantly lower in the endoscopic treatment group than that of the drug-treated group(P <0.02).(2)In Child-Pugh A patients: there were significant differences in the rate of rebleeding between the three groups at 1 year and 2 years(P<0.05),6 months rebleeding rate was no significant difference(P>0.05).The rate of rebleeding within 1 year and 2 years in surgical group was significantly lower than that in drug-treated group(P<0.02).In Child-Pugh B patients,there were significant differences in the rate of rebleeding between the three groups at 1 year and 2 years(P<0.05),6months rebleeding rate was no significant difference(P>0.05).The rate of rebleeding within 1 year and 2 years in surgical group was significantly lower than that in drug-treated group(P<0.02).The rate of rebleeding within 1 year in the endoscopic group was significantly lower than that in the drug-treated group(P<0.02).In Child-Pugh C patients,patients in the three groups had no significant difference in the rate of rebleeding in 6 months,1 year and 2 years(P <0.05).(3)There was no significant difference in mortality rate between the three groups of drug treatment group,endoscopic treatment group,and surgical group within 2 years(P>0.05).(4)There was significant difference in the distribution of liver function among the three groups(P<0.05).(5)There was no correlation between portal vein diameter and liverfunction child-pugh grade(P>0.05),and there was a positive correlation with esophageal varices(r=0.260,P=0.036).There was a significant negative correlation between the diameter of the portal vein and the length of rebleeding(r=-0.476,P<0.0001).Conclusion:(1)The surgical group had the lowest bleeding rate within 2 years.The incidence of rebleeding was lower in the surgical group and the endoscopic group than in the drug treatment group within 1 year and 2years.(2)Grade A and grade B of liver function were suitable for surgical treatment.The rate of rebleeding in 2 years was lower than that of drug treatment group and endoscopic treatment group.(3)There was no significant difference between the diameters of portal vein and the grade of liver function.There was a positive correlation between the diameter of portal vein and the degree of esophageal varices.There was a significant negative correlation between the diameter of the portal vein and the length of the rebleeding time,and the difference was statistically significant.