经皮经肝曲张静脉栓塞治疗断流术后食管胃底静脉破裂出血的疗效

Efficacy of percutaneous transhepatic variceal embolization in treating esophageal and gastric variceal bleeding after esophageal-gastric devascularization with splenectomy

目的研究以组织胶为主要栓塞材料，采用经皮经肝曲张静脉栓塞术（PTVE）治疗和预防门奇静脉断流术后食管胃底静脉曲张破裂出血的临床疗效。方法2006年11月至2008年9月，对22例曾行断流术再发食管胃底静脉曲张破裂出血的患者行PTVE组织胶栓塞（n=10）或内镜下硬化剂（EIS，n=12）治疗，随访两组患者治疗后再出血率、死亡率、治疗前后静脉曲张和肝功能以及PTVE治疗组患者在曲张侧支静脉栓塞前后门静脉压力的变化。结果①在平均12．5个月的随访期内，PTVE治疗组患者再出血率和死亡率分别为1／10和0；EIS治疗组随访13．4个月，患者再出血率和死亡率分别为7／12和3／12，两组间差异有统计学意义（P〈0．05）。②PTVE和EIS治疗均可显著减轻食管和胃底静脉曲张程度。③对有门静脉血栓患者，PTVE联合门静脉球囊成形术，可以改善肝脏门静脉血供。④PTVE和EIS治疗均未加重肝功能损伤。结论对门奇静脉断流术后食管胃底静脉破裂出血的患者，采用以组织胶为主要栓塞材料的PTVE治疗的疗效优于EIS治疗。

Objective To assess the efficacy of percutaneous transhepatie variceal embolization （PTVE） in treating esophageal and gastric variceal bleeding after esophageal-gastric devascularization with splenectomy in patients with liver cirrhosis. Methods Twenty-two patients, who had history of esophageal gastric devaseularization with splenectomy, were either underwent PTVE with TH glue （n=10） or endoscopic injection of sclerosis （EIS, n= 12） for treatment of esophageal or gastric variceal rebleeding between Nov. 2006 and Sep. 2008. The patients were followed-up for recurrent bleeding, mortality, grade of esophageal and gastric variees and liver function. Portal vein pressure was measured before and after collateral embolization in PTVE group. Results ① The patients were followed-up for 12.5 months in PTVE group and 13. 4 months in EIS group. There was significant difference （P〈0.05） between PTVE and EIS groups in rebleeding rate （1/10 vs 7/12） and mortality （0 vs 3/12）. ② The degree of esophageal and gastric varices after embolization or EIS was improved significantly. ③ For patients with portal vein thrombosis, combination of PTVE with portal vein balloon plasty could markedly improve portal vein blood supply. ④ Neither PTVE nor EIS aggravated the liver cirrhosis. Conelusion Compared with EIS, PTVE with TH glue may be a more effiective method in the treatment of rebleeding of patients with liver cirrhosis who had accepted esophagealgastric devascularization with splenectomy