联合介入栓塞对门脉高压性胃病的影响

Effect of combining interventional embolization on portal hypertensive gastropathy

目的探讨经皮经肝食管胃底静脉栓塞术联合部分脾脏栓塞术对门脉高压性胃病（PHG）的影响。方法采用经皮经肝TH胶定位栓塞胃冠状静脉（必要时联合栓塞胃短和胃后静脉）联合脾部分栓塞术（PTVE＋PSE），治疗肝硬化门脉高压症并上消化道出血病人53例。以48例行脾次全切除腹膜后移位加断流术的病人为对照，进行对比研究。随访2～48个月，平均16个月。结果（1）成功率：PTVE为92．3％，PSE达100％，PTVE死亡率1．9％，急症止血率100％，再出血率4．2％（对照组5．5％）。（2）研究组栓塞2个月、1年与栓塞前相比，PHG无明显变化（P〉0．05）；对照组术后2个月PHG程度比术前加重（P〈0．05），术后1年比术前减轻（P〈0．05）；研究组与对照组相比，PHG的变化无显著性差异（P〉0．05）。（3）研究组术后满1年的43例食管胃底静脉曲张者中，好转27例，消失7例，无变化8例，加重1例，而对照组47例中，好转25例，消失9例，无变化13例，两组疗效相似（P〉0．05）。（4）两组治疗结束时自由门静脉压力（FPP）均明显下降，研究组FPP平均减少（0．23±0．72）kPa，对照组平均减少（0．24±0．57）kPa。（5）研究组脾亢44例治愈，4例复发，复发者再次行PSE，脾亢消失。结论联合介入栓塞术疗效明显，止血确切，降低门脉压力显著，没有加重PHG，达到与脾次全切除腹膜后移位加断流术相似疗效。

Objective To study the effect of dual interventional embolization on portal hypertensive gastropathy. Methods In the treated group, percutaneous transhepatic varicieal embolization with TH glue combining with partial splenic embolization was performed in 53 patients of cirrhosis due to portal hypertension. In control group, 48 patients were treated by subtotal splenectomy with retroperitoneal splenic transposition and devascularization. The follow-up period ranged from 2 to 48 months （mean=16 months ）. Results 1） In the treated group, the successful rates of PTVE and PSE were 92.3% and 100%, respectively. The rates of emergency controlling, hemorrhage, rebleeding and death were 100%, 4.2% and 1.9%, respectively. In the control group, the rate of rebleeding was 5.5%. 2） In 2 months and 1 year after operation, PHG remained unchanged compared with that before operation in the treated group. In the control group, PHG in 2 months after operation was significantly aggravated compared with that before（P〈0.05）. In ] year after operation, PHG was significantly improved （P〈0. 05）. There was no significant difference between the two groups in change of PHG （P〉0.05）. 3） In the treated group, the rates of disappearance, improvement, absence of change and aggravation were 62.7%, 16.3%, 18.6%, 2.3%, respectively. In the control group, the rate of disappearance was 53. 1%, that of improvement 19.1% and that of absence of change 27.7 %. There was no significant difference between the two groups （P〉0.05）. 4） Free pressure of portal vein （FPP） was significantly declined after operation in both groups. The average decline of FPP was （0.23±0. 72）kPa and （0.24±0.57） kPa in the treated group and control group, respectively. 5） The rate of disappearance of hypersplenism was 91.7% （44/48）. Conclusion Dual interventional embolization has the advantage of controlling variceal hemorrhage and declining portal vein pressure but not aggravating PHG. This method has a similar effect of subtotal splenectomy with retroperitoneal splenic transposition and devascularization.