经皮经肝TH胶“三明治”栓塞术治疗食管胃底静脉曲张

Treatment of gastroesophageal varices bleeding by percutaneous transhepatic fixed TH glue embolization

目的：介绍经皮经肝1H胶“三明治”栓塞技术在胃冠状静脉栓塞术中的应用。方法：采用经皮经肝1H胶“三明治”定位栓塞胃冠状静脉（必要时联合栓塞胃短和胃后静脉）治疗食管胃底静脉曲张病人43例。27例病人同时行部分脾动脉栓塞；另9例既往己行脾切除＋断流术后，仅行TH胶定位栓塞；9例为急症栓塞治疗。结果：①33例成功，成功率92％；②近期效果：术后即刻食管胃底曲张静脉血流消失100％；术后27例复查，食管胃底静脉曲张基本消失16例（59．3％），减轻8例（33．3％），总有效率92．6％；③手术死亡率2．8％，未发生TH胶异位栓塞；④23例随访3—16个月（平均9．5个月），曲张静脉复发或加重2例（8．7％），再出血1例（4．3％），静脉曲张持续稳定占91．3％。结论：经皮经肝TH胶定位栓塞术操作安全、疗效确切，是食管胃底静脉曲张合理的介入治疗方法。

Objective： To study the clinical efllcaey and safety of fixed TH glue （a-cyanoacrylate） embolization in the treatment of gastroesophageal varices bleeding.Methods：Thirty-six patients were performed the procedures. TH glue was injected into the main stem of the feeder vein of varices and it＇s gastro-fundal branches followed placing steel coils,at the ostium of the feeder vein and injecting absolute alcohol in the varices. While 27 patients underwent variees embolization by the TH glue injection and partial splenic embolization, nine patients who underwent surgery before were performed the TH glue embolization alone, Results： ① The fixed TH glue embolization were performed on 33 patients, with a successful rate of 92% ;② Post venogram showed absence of gastroesophageal varices in all patients immediately; Twenty-seven patients underwent the gastroscopy or barium after the procedures： disappearance of varices in 18 cases （59.3%）, reduction in ealiter in 8 cases （33.3%） ; alleviation of hypersplenism in 24 of 25 patients （96%） ; ③ One patient died due to cerebral bleeding; no other sever complication occurred; ④ 23 patients were followed-up with a moan period of 8.5 months （2 - 16 months）; varices were controlled in 95.7% continuously, recurrence of varices in 2 patients, variceal reblceding in 1 patient.Conclusion：Our results suggest parcutaneous transhepatic fixed TH glue embolization is safe, reasonable and effective in treatment of hemorrhage from gastroesophageal varices.