Study On Prevention And Bleeding Treatment Of Endoscopic Variceal Ligation

Objective:Objective to investigate the difference between the prophylactic treatment of EVL and EVL in the treatment of bleeding,so as to provide more reasonable treatment and opportunity for patients with esophageal varices.Methods:From January 1,2014 to January 20,2021,432cirrhotic patients with esophageal varices treated with EVL were retrospectively analyzed.There were 202 patients in EVL group for preventive treatment and 230 patients in bleeding EVL group.The evaluation indexes included preoperative general information,blood routine,biochemistry,coagulation function,degree of ascites,Child-Pugh score,Child-Pugh grade,liver failure grade,number of blood transfusion,early rebleeding rate,mortality,length of hospital stay,total cost of hospitalization,etc.T-test,chi-square test,nonparametric test and binary logistic regression were used to analyze whether EVL preventive treatment is better than EVL treatment after bleeding.Results:1.There were significant differences in ascites degree,Child-Pugh grade and Child-Pugh score,liver failure grade between the two groups(χ2=36.208,P=0.000;χ2=32.474,P=0.000;Z=-6.338,P=0.000;χ2=31.075,P=0.000).2.There were significant differences in Hb,PLT,PT,INR and ALb between the two groups(t=11.349,P=0.000;t=-2.067,P=0.039;Z=-5.122,P=0.000;Z=-5.498,P=0.000;t=7.533,P=0.000).3.There were significant differences in the number of red blood cell transfusion and plasma transfusion between the two group(χ2=123.306,P=0.000;χ2=44.647,P=0.000),the amount of red blood cell transfusion,plasma transfusion,length of hospital stay and hospitalization expenses were statistically significant(Z=-1.381,P=0.000;Z=-5.752,P=0.001;Z=-3.386,P=0.001;Z=-8.507,P=0.000).4.The early rebleeding rate of the two groups after EVL was statistically significant(χ2=11.722,P=0.001).The mortality rates of the two groups were 0.0%(0/202)and 1.7%(4/230),respectively.The bleeding group had an upward trend,but the difference was not statistically significant(χ2=1.903,P=0.168).5.Compared between the primary prevention and secondary prevention groups,there were statistically significant differences in ascites,Hb,TBil,Child-Pugh scores,plasma transfusion volume,the number of plasma transfusions,hospitalization days andhospitalization expenses(χ2=6.058,P=0.014;t=3.812,P=0.000;Z=-3.276,P=0.001;Z=-2.288,P=0.022;t=2.584,,P=0.010;χ2=9.719,P=0.002;Z=-2.718,P=0.007;Z=-3.020,P=0.003).6.By binary logistic regression analysis,we found that preoperative Hb(OR=0.968,P=0.037),Child-Pugh score(OR=1.996,P=0.001),were risk factors for early rebleeding of esophageal varices in cirrhosis.Red blood cell transfusion(OR=11.104,P=0.000)and liver failure grade(OR=2.215,P=0.009)wererisk factors for EVL treatment in patients with liver cirrhosis.Conclusion:Compared with EVL after bleeding,EVL prophylaxis can prevent peritoneal effusion,hypohemoglobin,hypoproteinemia,and prolonged clotting time after bleeding,reduce rebleeding after EVL,reduce the occurrence of liver failure,reduce blood transfusion products,and save hospitalization costs of patients.Primary prevention of EVL has advantages over secondary prevention treatment;These results suggest that EVL prophylaxis should be actively considered in patients with cirrhosis of esophageal varices with EVL indications.