| Objectives:To compare the clinical efficacy,prognosis and safety of endoscopic varicose vein ligation and early transjugular intrahepatic portosystemic shunt in the treatment of esophageal variceal bleeding due to liver cirrhosisMethods:A retrospective analysis of 48 patients with acute EVB who were treated with EVL or early TIPS in our hospital from January 2014 to December 2016,including 20 patients in the EVL group and 28 patients in the early TIPS group.Completed within 5 days of bleeding.After 2 years of follow-up of the patients,the general data and clinical efficacy of the two groups of treatments(operation success rate,acute hemostasis success rate,gastroesophageal varices(GOV)outcome,and changes in portal vein pressure after TIPS)were compared.Rebleeding rate,survival rate,complications,laboratory indicators,length of hospital stay,number of times,and cost.Results:1.There was no statistically significant difference between the two groups in general information(age,gender,CTP grade,GOV degree and cirrhosis etiology)(P>0.05).2.The success rate of the two groups was 100%and there was no significant difference in the rate of successful haemostasis in the acute phase(95%vs.96.4%,p>0.05).After 2 weeks of treatment,the gastroscope was reviewed.The improvement rate of GOV in EVL group was 15%(3/20),the disappearance rate was 5%(1/20),the ineffective rate was 80%(16/20),and the improvement rate of GOV in early TIPS group was 67.9%(19/28),the disappearance rate was 17.9%(5/28),and the ineffective rate was 14.2%(4/28);Compared with the two groups,the improvement rate of GOV in the early TIPS group was higher than that in the EVL group(P<0.05).The early TIPS group had lower GOV inefficiency than the EVL group,the difference was statistically significant(P<0.05).Although the GOV disappearance rate was higher in the early TIPS group than in the EVL group,the difference was not statistically significant(P>0.05).The portal vein pressure after early TIPS treatment was significantly lower than that before treatment,from 28.73±6.36mmHg to 18.42±5.57mmHg,the difference was statistically signifieant(p<0.05).3.During the 2-year follow-up period,there were 15 patients With rebleeding in EVL group and 11 patients with rebleeding in early TIPS group.The incidences of early rebleeding,delayed rebleeding and non-bleeding in EVL group were 15.0%(3/20),55.0%(11/20)and 25.0%(5/20),respectively.The incidences of early rebleeding,delayed rebleeding and non-bleeding in early TIPS group were 3.6%(1/28),32.1%(9/28)and 60.7%(17/28),respectively.Compared with the early TIPS group,the non-bleeding rate in the early TIPS group was higher than that in the EVL group,and the difference was statistically significant(p<0.05).Although the rate of early rebleeding and delayed rebleeding in the EVL group was higher than that in the early TIPS group,there was no significant difference(P>0.05).The cumulative rebleeding rates in EVL group and early TIPS group were 75.0%and 39.3%respectively in 2 years.There was significant difference in Log-rank test(p<0.05).Three patients died of gastrointestinal bleeding in EVL group and two patients died of organ failure in early TIPS group.The 2-year cumulative survival rates in EVL group and early TIPS group were 85%and 92.8%respectively.There was no significant difference in Log-rank test(P>0.05).4.During the 2-year follow-up period,there were 3 cases of portal vein thrombosis(PVT),2 cases of hepatic Ca,2 cases of peritoneal effbsion,1 case of fever and 2 cases of gingival bleeding in EVL group;4 cases of PVT,3 cases of hepatic Ca,4 cases of peritoneal effusion,3 cases of fever and 5 cases of gingival bleeding in early TIPS group.There was no significant difference between the two groups(P>0.05).The incidence of hepatic encephalopathy(HE)in EVL group and early TIPS group was 5%and 39.30%,respectively,with significant difference(P<0.05).There was no significant difference in the rate of shunt stenosis between the covered stent group and the double stent group(P>0.05).5.The laboratory indexes of the two groups were compared before treatment and 1 month,3 months and 1 year after treatment,and the comparison was made between the two groups.Follow-up laboratory indicators included liver function(ALB,ALT,AST,TBIL),renal function(BUN,Scr),blood routine(WBC,HGB,PLT)and prothrombin time(PT).In EVL group,TBIL increased in 1 month,3 months and 1 year after treatment,and there was significant difference in 1 year after treatment compared with before treatment(P<0.05);WBC decreased in 1 month,3 months and 1 year after treatment compared with before treatment(P<0.05).In the early TIPS group,BUN decreased in 1 month after treatment,with statistical significance(P<0.05),increased in the follow-up process,but there was no significant difference(P>0.05);HGB showed an upward trend in blood routine,and increased in 1 year after treatment compared with before treatment,with statistical significance(P<0.05).The BUN in early TIPS group was lower than that in EVL group in one month after treatment(P<0.05);Scr in early TIPS group was lower than that in EVL group in three months after treatment(P<0.05);PT in early TIPS group was higher than that in EVL group in one month after treatment(P<0.05).6.There was no statistically significant difference in hospitalization days ansd frequency between the two groups(P>0.05).The cost of treatment in the early TIPS group was significantly higher than that in the EVL group,and the difference was statistically significant(92335.96±17189.9 vs 18649.27±5855.17,P<0.05).Conclusions:1.EVL and early TIPS in the treatment of acute EVB with cirrhosis have the same acute hemostatic effect.EVL has higher rate of re-bleeding than early TIPS,and it is more advantageous to prevent TIPS in early stage of re-bleeding.2.The portal vein pressure decreased significantly after early TIPS treatment,which greatly attenuated the degree of GOV,but the probability of concurrent HE was higher and expensive.3.The main cause of death in patients with EVL is mostly gastrointestinal hemorrhage.The main cause of death in TIPS patients is organ failure.There is no significant difference in EVL survival rate compared with early TIPS,indicating that early TIPS treatment can not significantly improve patient survival.4.The application of double stents in the early TIPS compared with the stent graft can not significantly improve the patency rate of the runner.5.Early TIPS compared with EVL treatment can improve the renal function of patients,and no significant liver and kidney function damage trends,safety is acceptable. |
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