经皮经肝TH胶灌注栓塞与内镜下套扎治疗食管胃底静脉曲张的对照研究

Comparison between PTVE of TH glue embolization through gastroesophageal and percutanenous and treatment of esophageal varices by variceal ligation

目的探讨经皮经肝TH胶（含显影剂的α-氰基丙烯酸正辛酯）灌注栓塞治疗食管胃底静脉曲张的可行性及近期疗效。方法将46例门静脉高压食管胃底静脉曲张破裂出血患者，随机分为两组：治疗组25例，采用TH胶“三明治”（无水乙醇-纤毛钢圈-TH胶）灌注栓塞胃冠状静脉＋部分脾动脉栓塞；对照组21例，采用食管胃底静脉曲张内镜密集套扎方法。分别观察食管胃底静脉再出血率、病死率、肝功能改善率。结果治疗组随访3～48个月，食管胃底静脉再出血率为8．7％，病死率为4．3％，肝功能改善率为87．0％；对照组曲张静脉再出血率为28．6％，病死率为19．0％，肝功能改善率为47．6％。结论TH胶“三明治”灌注栓塞胃冠状静脉联合部分脾动脉栓塞术操作安全，与内镜套扎方法比较，再出血率低、病死率低，肝功能改善率高，是治疗食管胃底静脉曲张的有效方法。

Objective To study the possibility and effects of fixed TH glue embolization through gastroesopbageal and percutanenous. Methods Forty - six patients of bleeding esophageal varices were divided randomly into two groups ： in treatment group ： twenty - five patients treated with TH glue （ α- cy- anoacrylate） embolization PTVE ＋ PSE. Absolute alcohol - cilia steel ring - TH glue , but in control group, 21 patients of esophageal varices by variceal ligation. Analysis the percentage of rebleeding, death rate and improvement rate of liver functions. Results In the treatment group, the rebleeding of gastroesophageal varices was 8.7%, the percentage of death was 4.3%, the function of liver improved by 87.0%. In the control group, the percentage of rebleeding was 28.6% , death rate was in 19.1% and liver function improved by 48.0%. Conclusion PTVE ＋ PSE fixed TH glue embolization is safe, less destroyed. Compared with dense edoscopic ligation, DEVL, the advantage is lessre bleeding, less death rate and higher liver function improvement rate. It is an effective method for gastroesophageal varices.