| Objective: To explore the curative effect of two methods of treatment of esophageal varicose vein hemorrhage: endoscopic ligation combined with medicine and medical medicine alone,and to provide theoretical guidance for clinical treatment.Methods: From October 2012 to December 2018,701 patients with cirrhotic esophageal variceal hemorrhage who were hospitalized in the liver and spleen center of Jiangsu Subei People's hospital were selected as the study subjects and divided into treatment group and control group.Clinical data,post-treatment liver function grading,hemostasis,post-treatment rebleeding,complications and death of the patients were counted.The relevant clinical data were analyzed by statistical method.Result: There were 533 patients in the endoscopic combined drug group(treatment group),including 344 males and 189 females.There were 168 patients in the drug group(control group),106 males and 62 females.1.General data: there was no significant difference between the two groups of patients in terms of gender,age,etiology of cirrhosis,and liver function Child-Pugh classification,and there was no statistical significance(P>0.05),and they were comparable.2.Laboratory test results: the P values of other laboratory test indicators except creatinine in both groups were> 0.05,which was not statistically significant and comparable.3.Imaging and endoscopy results: there was no significant difference between the two groups of patients in terms of the internal diameter of portal vein trunk,portal vein thrombosis,red sign,thrombus head,and esophageal severity(P>0.05).All are comparable.4.Comparison of Child-Pugh classification of liver function before and after treatment:Child-Pugh classification of liver function after one year of treatment in the endoscopiccombined drug group was significantly improved compared with that before treatment,and the difference was statistically significant(P<0.05);Child-Pugh classification of liver function after one year of treatment in the drug group was not significantly improved compared with that before treatment,and the difference was not statistically significant(P>0.05);the comparison of child-pugh grading of liver function between the two groups after 1 year of treatment showed that the endoscopic combined drug group was superior to the drug group,and the difference was statistically significant(P<0.05).5.Success rate of hemostasis: 512 cases of successful hemostasis(96.1%)in the endoscopic drug group and 138 cases(82.1%)in the drug group were successful hemostasis.The success rate of hemostasis in the endoscopic drug group was significantly higher than that in the drug group,and the difference was statistically significant(P<0.05).6.Rebleeding rate: there were 31 cases(5.8%)of early rebleeding in the endoscopic drug group,57 cases(33.9%)of early rebleeding in the drug group,58 cases(10.9%)of late rebleeding in the endoscopic drug group,and 60 cases(35.7%)of late rebleeding in the drug group.The rate of early and late rebleeding in the endoscopic drug group was significantly lower than that in the drug group,and the difference was statistically significant(P<0.05).7.Risk factors of early rebleeding after treatment were analyzed in the treatment group:multiple factors Logistic regression analysis results show: the total bilirubin,and prothrombin time,portal venous trunk diameter and liver function Child-Pugh,hierarchical regression coefficient is positive,the OR value is greater than 1,is an independent risk factor for early rebleeding after treatment in the treatment group,the OR value is less than 1,is its protection factor,difference had statistical significance(P<0.05).8.Complications: 69 cases(13.0%)of fever,103 cases(19.3%)of retrosternal pain,66cases(12.4%)of deglutition obstruction and 28 cases(5.2%)of esophageal ulcer in the endoscopic combined drug group.There were 35 cases of fever(20.8%),10 cases ofretrosternal pain(6.3%),15 cases of deglutition obstruction(8.9%),and 6 cases of esophageal ulcer(3.6%)in the drug group.There were no esophageal perforation,empyema and other complications in the two groups.The most common adverse reactions in the endoscopic drug group were retrosternal pain,while the drug group was febrile.Compared to the drug group,endoscopic heating rate of combined drug group was obviously lower,and significantly higher incidence of retrosternal pain,two groups on the incidence of fever and retrosternal pain have significant difference,was statistically significant(P<0.05),between the two groups of swallowing obstruction and esophageal ulcer incidence,though there are differences,but no statistical significance(P>0.05).9.Survival analysis: endoscopic combined drug group of arithmetic mean and the median survival time of 56 and 60 months,respectively,and the drug group of 42 respectively and 35 months,longer duration of follow-up,patients with endoscopic combined drug group of cumulative survival rate is higher than drug group,Kaplan-Meier survival analysis shows there are differences between the two groups of the comparison of survival time,statistically significant(P<0.05).Conclusion:1.After 1 year of treatment,the liver function of the endoscopic drug group was significantly improved,while the liver function of the drug group was not significantly improved after 1 year of treatment.2.The success rate of hemostasis in the endoscopic drug group(96.1%)was significantly higher than that in the drug group(82.1%).3.The rate of early rebleeding(5.8%)in the endoscopic drug group was significantly lower than that in the drug group(33.9%),and the rate of late rebleeding(10.9%)in the endoscopic drug group was significantly lower than that in the drug group(35.7%).4.Total bilirubin,prothrombin time,portal vein trunk diameter and child-pugh grading of liver function were independent risk factors for early rebleeding after endoscopic drug group and albumin was the protective factor.5.The most common adverse reactions in the endoscopic drug group were retrosternal pain,while the drug group was febrile.Compared with the drug group,the fever rate ofthe endoscopic combined drug group was significantly lower,while the incidence of retrosternal pain was significantly higher.6.With the extension of follow-up time,the cumulative survival rate of patients in the endoscopic combined drug group was higher than that in the drug group,and the survival rate of patients with cirrhotic esophageal varices bleeding could be improved by the combination of endoscopic ligation and drug therapy. |
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