内镜下套扎联合经皮经肝TH胶栓塞治疗肝硬化食管胃底静脉曲张的临床应用

The clinical efficacy of endoscopic variceal ligation combined with percutaneous transhepatic varices embolization

目的评价内镜下套扎（EVL）联合经皮经肝曲张静脉TH胶栓塞术（PTVE）治疗肝硬化食管胃底静脉曲张出血的远期疗效。方法 44例肝硬化食管胃底静脉曲张出血患者,先行食管曲张静脉的内镜下套扎治疗,1周后再行TH胶PTVE,栓塞食管胃底曲张静脉区域及其来源血管。联合治疗术后定期复查胃镜,观察曲张静脉消失情况,随访治疗后曲张静脉复发率及再出血率。结果 44例食管胃底静脉曲张患者,32例食管曲张静脉基本消失,消失率72.7%;8例胃底静脉曲张基本消失,消失率100%;12例食管静脉曲张程度明显减轻,总有效率100%。随访6~39个月,平均25.6个月,5例食管静脉曲张复发,复发率11.4%;3例再出血,再出血率6.8%。结论内镜下套扎治疗能机械性地消除食管曲张静脉,经皮经肝TH胶栓塞能栓塞食管胃底曲张静脉区域及其供血血管,二者联合能达到协同作用,具有更好的远期疗效。

Objective To evaluate the long-term effect of endoscopic variceal ligation（EVL） combined with percutaneous transhepatic varices embolization with TH adhesive（PTVE） in cirrhosis accompanied with esophagogastric varices with bleading.Methods EVL was performed on 44 patients.One week later,PTVE was performed on all patients where the TH adhesive was injected into the main stem of left gastric vein and its fundic branches.Endoscopy was performed to observe the disappearance of esophageal varices.Recurernce rate and rebleeding rate were also calculated.Results In 32（72.7%） of 44 patients,the esophageal varices disappeared after EVL and PTVE.In all 8 patients with gastric varices, the gastric varices disappeared.In 12 of 44 patients,the severity of esophageal varices reduced obviously,the overall effective rate was 100%.During a follow-up period of 6～39 months（with the mean of 25.6 months）,recurrent varices occured in 5（11.4%） of 44 patients,recurrent bleeding occured in 3（6.8%） of 44 patients.Conclusion EVL can eliminate the esophageal varices mechanically,while PTVE with TH adhesive can block the feeding veins of varices.Therefore,the combination of EVL with PTVE is reasonable and effective with a satisfactory long-term efficacy.