内镜套扎联合部分脾动脉栓塞术治疗门静脉性上消化道急性出血的研究

Clinical study of endoscopic variceal ligation combined with partial splenic embolization in the patients with acute portal upper digestive track bleeding

目的 探讨急诊内镜套扎联合部分脾动脉栓塞术治疗门静脉高压并发上消化道急性出血的疗效。方法 对 4 8例门静脉高压并食管胃底静脉曲张破裂急性出血患者行急诊内镜下曲张静脉套扎术(EVL) ,联合部分脾动脉栓塞术 (PSE) ,观察近期止血效果和远期再出血发生率及外周血细胞等变化。结果 EVL PSE联合术近期止血效果显著 (10 0 % ) ,食管胃底曲张静脉消失率达 6 8.75 % (33/48) ;无手术死亡 ,无严重并发症 ,远期再出血率 6 .2 5 % (3/48) ,外周血白细胞及血小板均较术前明显回升 (P <0 .0 5 )。结论 联合术能有效地救治门静脉高压并食管胃底静脉曲张破裂急性出血 ,减少单纯内镜下套扎治疗的次数和复发再出血的风险。该法创伤小 ,安全有效。

Objective To discuss the clinical effect of the emergency endoscopic variceal ligation combined with partial splenic embolization(EVL-PSE) for patients with portal hypertension and acute portal upper digestive bleeding.Methods EVL-PSE was performed to treat 48 patients with portal hypertension and subsequent acute bleeding of esophageal varices rupture. The changes of the short-term hemostasia effect and the long-term recurrent bleeding were observed.Results The short-term hemostasia effect of EVL-PSE was remarkable (100%) and varices were eradicated in 68.75%(33/48).No severe complications and operative death were associated with EVL-PSE .The long term recurrent bleeding occurred in 6.25%(3/48) of 48 patients.The levels of platelet and leucocyte were remarkably increased compared with previous levels(P<0.05).Conclusion EVL-PSE may effectively treat portal hypertension and subsequent acute bleeding of esophageal varices rupture,which decreases the times of single endoscopic ligation and the risk of recurrent rebleeding,with less trauma and more safety.