TH胶在经皮经肝穿刺食管胃底静脉曲张栓塞治疗中的应用

Application of TH glue (cyanoacrylate) in embolization treatment of esophago-gastric varices

目的评价TH胶在经皮经肝穿刺食管胃底静脉曲张栓塞中的应用价值。方法肝硬化门静脉高压并食管胃底静脉曲张患者20例,其中男性14例,女性6例。年龄25～72岁,平均年龄52岁。静脉曲张程度轻度2例,中度12例,重度6例。肝功能Child-Paugh分级A级15例,B级5例。采用经皮经肝门静脉穿刺途径,用TH胶灌注填塞曲张静脉,在拔出导管鞘时用1～2mlTH胶填塞肝脏穿刺通道。结果20例患者食管胃底静脉曲张即时闭塞率100%(20/20),肝脏穿刺通道填塞良好,未出现肝包膜严重出血。肝功能各项指标在术后3d一过性升高,术后1个月恢复正常。17例患者随访6～12个月,随访期间无食管胃底静脉破裂出血。无死亡病例。结论TH胶能即时闭塞食管胃底的曲张静脉,治疗和预防曲张静脉破裂出血,也能够即时填塞肝脏穿刺通道,防止肝包膜下出血,在门静脉高压并食管胃底静脉曲张的介入栓塞治疗中具有重要的应用价值。

Objective To study the clinical value of TH glue （cyanoacrylate） in treatment of esophago-gastric varices by percutaneous transhepatic embolization. Methods Twenty patients with port hypertension combined with esophago-gastric varices were enrolled in this study, male 14 and female 6 ,aged from 25 to 72 years, mean age 52 years. Child-Paugh grade of liver functions were grade A 15 and grade B 5 cases in 20 patients. The degree of varices classed as mild degree in 2 cases, middling degree in 12 cases and severe degree in 6 cases. TH glue was injected into the main left gastric vein and short gastric vein by percutaneous transhepatic portal vein puncturing method. Before pulled out catheter introducer, 1 - 2 ml TH glue was infused into liver punctured tract. Results Immediately occlusion rate of esophago-gastric varices was 100 % （20/20）. Punctured tract of the liver were filled in reassuringly, and no severe liver bleeding were found. The index of liver function increased transiently after 3 days,and were normal after 1 month. The follow-up duration was 6 - 12 months in 17 cases,no hemorrhagic esophago-gastric veins happened in follow up time. Mortality was zero. Conclusion TH glue could block the esophago-gastric varices immediately after injection, so could be used as an effective material of treating and preventing varices rupture bleeding. TH glue could also clog liver punctured tract and prevent liver bleeding. TH glue plays an important role in interventional therapy of esophago-gastric varices.