ABSTRACT
Objective To explore the efficacy of sequential endoscopic variceal ligation plus endoscopic variceal sclerotheropy and the factors associated with the prognosis.Methods 106 cases with esophageal varices in control group was treated with drugs alone;study group had 113 cases, was given endoscopic therapy add drugs, The study group randomly divided into two groups, one was treated with endoscopic variceal ligation all the time (EVL group), another was treated with sequential endoscopic variceal ligation plus endoscopic variceal sclerotheropy (sequential group). After the treatment, the rate of removal of varicose veins, the rate of rebleeding, the number of total treatment,mortality and intra-operative complications and postoperative complications were compared. And compared rebleeding rate and mortality with the control group and study groups with different CTP and MELD, analyze the factors of prognosis, and evaluate their prognostic value.Results Rebleeding, rate in control group, EVL group and sequential group were 41.51%,10.53% and 10.64%,sequential group was significantly better than control group (P = 0.000); mortality in control group, EVL group and sequential group were 15.09%, 5.26% and 2.13%, sequential group was also significantly better than control group (P = 0.001); rate of recurrence in EVL group and sequential group within half a year were 73.68% and 44.68%, sequential group was significantly better than EVL group (P = 0.021). In all control group and EVL group and the sequential group, rebleeding rate and mortality of the liver function Child-Turcotte-Pugh (CTP) class C was significantly higher than that of calss A; In MELD model, AUC area under the ROC curve of rebleeding rate in control group and sequential group were 0.944 and 0.851, mortality of the two groups were 0.881 and 0.984, while the rate of recurrence in the EVL group and sequential group were respectively 0.914 and 0.765, the MELD score has the important value to the prediction of rebleeding and death.Conclusion The rebleeding rate and mortality in cirrhotic patients with esophageal varices treated with sequential endoscopic variceal ligation plus endoscopic variceal sclerotheropy were significantly decreased and the recurrence rate was lower than that of the patients with endoscopic variceal ligation all the time. Liver function Child-Turcotte-Pugh (CTP) score and the MELD score have important value in prediction of rebleeding and death, ligation and sclerosing sequential therapy can significantly reduced rebleeding and mortality in CTP class B and C, and improve the MELD threshold of rebleeding and death.
ABSTRACT
Objective To observe and study the therapeutic effect of ctreotide combined with omeprazole in the treatment of liver cirrhosis with upper gastrointestinal bleeding.Methods 76 cases of patients with upper gastrointestinal bleeding caused by liver cirrhosis were selected in our hospital from January 2013 to December 2014 to be separated into the observation group and control group randomly, with each group having 38 patients.Patients in two groups were all given symptomatic treatment first.Patients in control group were given 0.1 mg octreotide dissolved 20 mL 0.9% sodium chloride solution by intravenous injection in the first administration.And the rest octreotide was given by intravenous drip at the speed of 25μg/h.The treatment lasted for 72 h.On the base of control group, patients in observation group were given 40 mg omeprazole dissolved 100 mL 0.9%sodium chloride solution additionally, twice daily, for 3 d.Then the therapeutic effect, hemostatic time, blood transfusion, rebleeding rate and adverse reactions of patients in two groups were observed.Results The total effective rate of observation group 89.47%was much more than control group 63.16% (P<0.05).And the apparent rate of observation group 55.26%was also more than control group 31.58% ( P <0.05 ) .Both the hemostatic time and blood transfusion of observation group is less than control group ( P <0.05 ) .Besides, the rebleeding rate of observation group 5.26% is much less than control group 21.05% ( P<0.05 ) ., Incidence rates of adverse reactions in two groups were 10.53% and 7.89%, with no statistically significant difference. Conclusions Treatment of octreotide combined with omeprazole on patients with upper gastrointestinal bleeding caused by liver cirrhosis can improve the therapeutic effect, shorten the hemostatic time and decrease the blood transfusion with low rebleeding rate and few adverse reaction.