食管胃底曲张静脉栓塞加脾动脉栓塞法治疗急诊肝硬化上消化道大出血

Percutaneous transhepatic variceal embolization(PTVE)and partial splenic embolization(PSE) to treat acute upper gastrointestinal bleeding in patients with liver cirrhosis

目的探讨应用经皮经肝食管胃底曲张静脉栓塞（P1VE）联合经皮部分性脾动脉栓塞（PSE）治疗肝硬化门脉高压所致的急诊上消化道大出血的有效性和安全性。方法回顾性分析36例肝硬化门脉高压（不合并肿瘤者）所致的急诊上消化道大出血患者，均急诊行NBCA胶加弹簧圈栓塞食管胃底曲张静脉治疗，再于一周后行部分性脾动脉栓塞术，分析36例病例的近期疗效（6～18月）、并发症，评价该方法的有效性和安全性。结果36例病例均应用NBCA胶和弹簧圈栓塞食管胃底曲张静脉，术中术后未出现重大手术并发症，术后跟踪随访6～24月，有4例患者出现上消化道出血复发，其中1例患者复发出现在介入栓塞后的第二天，再次行栓塞治疗后好转，余3例患者复发的上消化道出血均不严重，经内科保守治疗后恢复。结论NBCA胶配合弹簧圈栓塞食管胃底曲张静脉治疗肝硬化门脉高压所致的上消化道出血是有效的安全性，加用部分性脾动脉栓塞术可降低门静脉压力，提高单纯性食管胃底曲张静脉栓塞的疗效。

Objective To evaluate the efficacy and safety of PTVE with PSE in the treatment of acute upper gastrointestinal bleeding owe to severe cirrhosis. Methods Retrospective analysis of 36 patients admitted from December 2003 to December 2006, with severe cirrhosis and portal hypertension resulting from active upper gastrointestinal bleeding （without carcinoma）. All these patients received the emergency therapy of PTVE（ with NBCA and coils） and PSE one week later. The efficacy and safety of this method was evaluated by analyzing the effects in the near future （6 - 18 months） and complication. Results Successful catheterization and embolization of the varices was performed in all of the 36 cases without serious complication. Following - up 6 - 24 months,4 patients suffered from bleeding recurrence,one recovered by a second embolization, whose bleeding recurrence appeared at the 2nd day following PTVE, while the other 3 patients had no serious bleeding recurrence and recovered from conservative treatment by medical resume. All of the 4 patients received PSE one week later. Conclusions PTVE is effective and safe in the near future in treatment of acute gastroesophageal bleeding owe to severe cirrhosis. PSE can reduce portal venous pressure and enhance the effects of PTVE. It is a good method of dealing with acute gastroesophageal bleeding in patients with severe cirrhosis.