| Background and ObjectivesPortal hypertension is one of the common complications of patients with liver cirrhosis.Because the portal vein system of the liver lacks venous valves and there are communicating branches between the portal vein system and the vena cava of the liver,in order to relieve the pressure of the portal vein,the blood vessels of the portal vein system of the liver are established through anastomotic branches.In addition to the common gastric veins,esophageal veins and abdominal varicose veins,the branch circulation can also form spontaneous splenorenal shunt and gastrorenal shunt;.However,little is known about the characteristics of spontaneous splenorenal shunt or gastrorenal shunt at present.Understanding the clinical characteristics of patients with cirrhosis of the spontaneous splenorenal shunt or gastrorenal shunt;will help us improve our understanding of this special type of shunt,and enable us to provide decision-making ideas for the clinical treatment of these patients,so as to provide such patients with more standardized Individualized treatment.For the treatment of gastric varices with the spontaneous splenorenal shunt or gastrorenal shunt,the current domestic and foreign guidelines are not covered,and the existing treatment options are still controversial and have limited clinical applications.Due to the existence of the spontaneous splenorenal shunt or gastrorenal shunt,the risk of ectopic embolism is higher with conventional tissue glue injection treatment.For such patients with gastric varices,we use "hypertonic sugar+tissue glue+normal saline" Sandwich therapy has achieved good results,and it is reported as follows.This paper is mainly divided into two parts.In the first part,we reviewed the clinical data of 46 patients with liver cirrhosis and the spontaneous splenorenal shunt or gastrorenal shunt who were treated at Qilu Hospital of Shandong University from 2015.02 to 2021.02,and summarized and analyzed liver cirrhosis.Clinical data characteristics of patients with the spontaneous splenorenal shunt or gastrorenal shunt;In the second part,we reviewed the Qilu Hospital of Shandong University,Zibo First Hospital Affiliated to Qilu School of Medicine and Jinxiang Hospital Affiliated to Jining Medical College from February 2015 to February 2021.The township hospital performed the modified "sandwich method" tissue glue under gastroscopy to treat the clinical data of 13 patients with gastric varicose veins and gastroscopy.A preliminary analysis of the "hypertonic sugar+tissue glue+physiological saline" sandwich method for the treatment of cirrhosis of the spontaneous splenorenal shunt or gastrorenal shunt.The therapeutic effect of renal shunt combined with gastric varices.Clinical characteristics of patients with cirrhosis of spontaneous splenorenal shunt or gastrorenal shuntObject and MethodThis study reviewed the medical records of 2213 patients with liver cirrhosis who were admitted to Qilu Hospital of Shandong University from February 2015 to February 2021.A total of 46 patients with spontaneous splenorenal shunt or gastrorenal shunt were found,and they were randomly selected from the medical record system during the period from February 2015 to February 2021.49 patients with liver cirrhosis treated in Qilu Hospital of Shandong University served as a control group.According to whether the patient is combined with spontaneous splenorenal shunt or gastrorenal shunt,the patient is divided into a spontaneous portosystemic shunt group and a control group(no shunt group).By collecting the clinical characteristics,laboratory indicators and gastroscopy of the two groups of patients,compare the differences in the etiology,main symptoms,hepatic encephalopathy,portal hypertensive gastropathy,liver function reserve and other clinical features between the two groups of patients to describe Its clinical characteristics.This study adopts retrospective observation research methods.Measurement data conforming to the normal distribution are expressed as mean±standard deviation.Differences between groups are expressed by one-way analysis of variance.Those that do not conform to the normal distribution are expressed by median and interquartile range.Differences between groups are expressed by rank sum test.All data were processed and analyzed using IBM SPSS Statistics 26 software,using a two-way test,P<0.05 was statistically significant.Results1.According to the analysis of the etiology of the two groups of patients,there were 0 cases of alcoholic hepatitis in the spontaneous portosystemic shunt group(0.0%),and 5 cases of alcoholic hepatitis in the control group(10.2%),the p value was 0.009,the difference was statistically significant(P<0.05),all patients with alcoholic hepatitis as the cause did not have spontaneous shunt.2.Among the patients with hematemesis,fever,nausea and vomiting in this study,10 cases(21.7%),6 cases(13.0%),and 14 cases(30.4%)were combined in the spontaneous portosystemic shunt group,respectively.The control group Respectively accounted for 25 cases(51.0%),0 cases,25 cases(51.0%),there were differences in the composition of hematemesis,fever,nausea and vomiting between the two groups.The p values were 0.003,0.003,0.042,and the differences were statistically significant(p<0.05).3.Among the patients with hepatic encephalopathy,splenomegaly,and portal hypertensive gastropathy in this study,5 cases(10.9%),36(78.3%),5 cases(10.9%)were combined in the spontaneous portosystemic shunt group,respectively);the control group accounted for 0 cases,23 cases(46.9%),22 cases(44.9%),the differences were statistically significant,the p values were 0.018,0.005,0.000,and the differences were statistically significant(p<0.05).4.Among patients with liver cirrhosis with spontaneous portosystemic shunt,Child-Pugh B or C accounted for a larger proportion.There are differences in the total Child-Pugh score and the proportions of A,B,and C between the two groups.,P values were 0.008 and 0.001 respectively,the difference was statistically significant(p<0.05).Conclusions1.Alcoholic hepatitis may be related to the spontaneous portosystemic shunt of liver cirrhosis and patients with spontaneous splenorenal shunt or gastrorenal shunt are more likely to develop infections.2.The existence of the spontaneous splenorenal shunt or gastrorenal shunt can reduce the incidence of portal hypertension gastric disease and reduce gastrointestinal bleeding,but it is more prone to splenomegaly and hepatic encephalopathy.The liver function classification is more inclined to Child-Pugh B or C.Analysis of the Effect of Endoscopic Treatment of Gastric Varices Combined with spontaneous splenorenal shunt or gastrorenal shuntObject and MethodCollected 13 cases of gastric varices patients who underwent gastroscopy in Qilu Hospital of Shandong University,Zibo First Hospital Affiliated to Qilu Medical College,and Jinxiang Hospital Affiliated to Jining Medical College from 2015.02 to 2021.02.Clinical data,gastroscopy and follow-up results,preliminary analysis of the"hypertonic sugar+tissue glue+saline" sandwich method in the treatment of gastric varices with spontaneous splenorenal shunt or gastrorenal shunt.Record the types of gastric varices,the amount of tissue glue,the average number of injection points,and whether there are new postoperative coughs,abdominal pain,chest pain,chest tightness,shortness of breath,and symptoms and signs related to cerebral infarction.Follow up gastroscope and portal vein CTA,observe and record the treatment effect.All data are processed and analyzed using IBM SPSS Statistics 26 software.Results1.A total of 13 patients were enrolled in this study,including 11 patients with gastrorenal shunt(85%)and 2 patients(15%)with spontaneous splenorenal shunt or,including 9 patients with IGV1 type,2 patients with IGV2 type,1 patient with GOV1 type,and 4 patients with GOV2 type,Among them,there are 3 patients,combined with the above two types of gastric varices.2.Of the 13 patients,2(15%)patients developed abdominal pain after surgery,which was pain under the xiphoid process.The pain scores of the patients were 2 and 3 points,respectively.One patient(8%)was not given treatment and spontaneously after a short clinical observation.Remission,another case(8%)was relieved 15 minutes after the gastric mucosal protective agent was administered.Another 4 patients(30%)experienced postoperative nausea and vomiting.Of these,2 patients(15%)did not receive treatment and resolved spontaneously after clinical observation.Among them,2 patients(15%)improved after antiemetic treatment.All patients had no clinical manifestations and signs of ectopic embolism,such as new cough,chest pain,chest tightness,shortness of breath,and cerebral infarction.Postoperative re-examination of the portal vein CTA did not find the imaging manifestations of ectopic embolism.It can be seen that the tissue glue blocked the blood flow of the gastric varices and the tissue glue was confined in the varicose veins,and no ectopic emboli was found.3.Among the 13 patients,only 1(8%)had melena on the 6th day after the operation,the volume was small,about 50ml,there was no hematemesis,abdominal pain,chest pain,and did not go to the doctor.No new cough,chest pain,chest tightness,shortness of breath and cerebral infarction related symptoms and signs occurred in all patients after operation and follow-up.Among 13 patients,10 patients(85%)showed that the varicose veins had disappeared or basically disappeared after the gastroscopy,and 1 patient(8%)found a new varicose vein in the fundus of the stomach during the gastroscopy 4 weeks postoperatively,and the remaining varicose veins The veins had basically disappeared,and the modified sandwich method of hypertonic sugar was given again.Two patients(15%)did not undergo gastroscopy.Conclusions1.The hypertonic sugar-modified sandwich method tissue glue has good safety and effectiveness in the treatment of the spontaneous splenorenal shunt or gastrorenal shunt and gastric varices.It is worthy of further research and verification in large-scale,multi-center,randomized controlled trials.This method is simple and easy to operate.It may provide a choice for the majority of primary hospitals. |
