组织胶经皮经肝食管胃曲张静脉栓塞术治疗肝硬化胃静脉曲张破裂出血远期疗效评价

Evaluation of long-term efficacy of percutaneous transhepatic variceal emobolization with TH glue in the treatment of gastric variceal bleeding

目的评价组织胶经皮经肝食管胃曲张静脉栓塞术（胛VE）治疗肝硬化胃静脉曲张破裂出血的远期疗效。方法2007年1月至2011年12月山东大学附属山东省立医院收治的经内镜检查证实并采用组织胶（TH胶）行PTVE治疗79例肝硬化胃静脉曲张破裂出血患者。其中急性胃静脉曲张破裂出血患者9例，近期出血70例。结果本组76例患者栓塞成功，成功率96．2％（76／79）。经PTVE治疗后，69例患者胃曲张静脉及供血静脉完全闭塞。9例急性出血患者术后止血率为100％。术后随访时间6—59个月，平均（28．2±17．4）个月。术后第1、3、5年患者累计未再出血率分别为97．8％、76．1％和76．1％。丌Ⅵ￡后随访CT检查证实TH胶能够持久滞留于食管胃底周围静脉内，使曲张静脉及供血静脉长期闭塞。术后第1、3、5年患者累计生存率分别为96．3％、69．5％和49．1％。结论组织胶PTVE能持久性闭塞胃底曲张静脉，预防静脉曲张破裂再出血，是胃底静脉曲张破裂出血的有效治疗方法，但应掌握操作技巧，减少手术并发症的发生。

Objective To evaluate the long-term eiticacy of modified pereutaneous transhepatic variceal embolization （FIVE） with TH glue in the treatment of gastric variceal bleeding. Methods From January 2-37 to December 2011, 79 patients with a history of gastric variceal bleeding underwent the modified PIVE with TH glue in Shandong Provincial Hospital Afl＇diated to Shandong University. Nine patients with acute gastric variceal bleeding received emergency obliteration. The remaining 70 patients with recent variceal bleeding received PIVE as a secondary prophylaxis. Results Seventy-six cases were embolized successfully, and the success rate was 96. 2% （76/79）. Gastric varices of 69 cases and their feeding veins entirely obliterated after PFVE procedure. The hemostasis rate after PTVE procedure in the 9 patients with acute variceal bleeding was 100%. The moan follow-up period was （28.2 ± 17.4） months （range： 6 to 59 months）. During the follow-up period, the cumulative probability of remaining free of gastric variceal rebleeding in patients with complete obliteration was 97. 8%, 76.1%, and 76.1% in 1, 3, and 5 years. Follow-up computed tomography （CT） revealed that the TIVE with TH glue effectively obliterate the entire varices and the feeding veins. The cumulative survival rates at 1, 3 and 5 years were 96.3%, 69.5%, and 49. 1%. Conclusion With enduring obliteration of both gastric varices and the feeding veins, the modified FIVE with TH glue is effective in the treatment of gastric varices, but doctors should master operative skills in order to reduce complications.