经皮胃冠状静脉栓塞联合部分脾栓塞术治疗门静脉高压症

Therapeutic Effect of Percutaneous Transhepatic Gastroesophageal Variceal Embolization Combined with Partial Splenic Embolization for Portal Hypertention

目的:探讨联合介入术在治疗门静脉高压症中的作用。方法:对50例高危门脉高压患者随机分组,A组25例行胃冠状静脉栓塞术(PTVE)联合部分脾栓塞术(PSE),B组25例行单纯PSE术,所有患者于术前和术后分别行彩色多普勒和测压导管检查了解门静脉侧支循环、门静脉压力,对两组的各项指标进行对比分析。结果:两组行介入术后脾功能亢进均得到缓解,采用联合介入术式的患者曲张静脉全部得到栓塞;A、B两组术前、术后门静脉内径均变小,血流速度减慢,两者差异无统计学意义(P>0.05),但B组门静脉压力减低较A组明显(P<0.05);A组奇静脉内径变小,血流速度减慢(P<0.05),B组奇静脉内径无变化,流速减慢,两组间奇静脉血流量下降幅度有明显差异(P<0.01)。结论:联合介入术能有效治疗门脉高压食管胃底曲张静脉破裂出血和脾功能亢进,该方法侵袭性小,适用于肝功能差不能耐受外科手术的患者,具有较高的临床应用价值。

Objectve：To evaluate the efficacy of percutaneous transhepatic variceal embolization （PTVE） combined with partial splenic embolization （PSE） for portal hypertension. Methods：50 patients with portal hypertension were divided randomly into 2 groups,with 25 patients for each group. Group A underwent PTVE combined with PSE and group B were treated with PSE only. Color Doppler ultrasonography and pressure measurement via catheter were undertaken pre-and post-operation in order to obtain the data including changes of collateral circulation as well as the pressure of the portal vein. The results of these two groups were compared and analyzed. Results： Hypersplenism was well controlled in both groups after interventional treatment. The varices of group A were embolized completely; of the group A and B pre-and post-operation, significant reduction of the flow rate of portal blood stream as well as the internal dimension of portal vein were existed, there was no statistical difference （P〉0.05） ;yet reduction of portal vein pressure in group B was more obvious than that of group A （P（0.05）;in group A, reduction of the flow rate and velocity together with decrease of inner diameter of azygos vein could be assessed （P〈0.05） ;no change of internal dimension of azygos vein could be shown in group B,but the flow velocity reduced, marked statistical difference was assessed in the decrease of blood volume of azygos vein （P〈0.01）. Conchtsion：Gastroesophageal variceal bleeding and hypersplenism could be treated effectively by PTVE and PSE,which is less invasive and especially useful for patients with poor hepatic function and surgical treatment is contraindicated. PTVE combined with PSE plays an important role in clinical practice.