影响经皮经肝食管胃曲张静脉组织胶栓塞术远期疗效因素分析

To analysis the factors that effect the prostecdtive efficacy of percutaneous transhepatic varices embolization

目的:探讨提高经皮经肝曲张静脉栓塞术(PTVE)治疗食管胃底静脉曲张出血远期疗效的相关因素。方法:192例肝硬化合并食管胃底静脉曲张出血的患者,经皮经肝穿刺向食管下段胃底部曲张静脉、食管下段周围静脉丛、胃底贲门周围静脉丛内注入永久性栓塞剂TH胶(a-氰基丙烯酸酯)。结果:192例患者中188例成功施行了PTVE,成功率达97.8%。168例患者随访期6～64月,根据注入的TH胶分布的范围,168例患者分为3种栓塞类型:食管-胃底型82例,胃底型67例,主干型19例,135例患者PTVE后同时施行部分脾动脉栓塞,42例随访中施行了内镜下套扎或硬化治疗。静脉曲张复发率15.5%(26/168)。胃食管栓塞组静脉曲张复发率明显低于胃底贲门型及冠状静脉主干型(P<0.0001,log-ranktest)。随访期间21例患者再出血,总出血率12.5%(21/168)。其中食管胃底型再出血率3.7%(3/82);胃底型再出血率10.4%(7/67);主干型再出血率58.1%(11/19)。联合内镜治疗者再出血为2.4%(1/42),联合脾动脉栓塞组再出血8.9%(12/135)明显低于单纯PTVE治疗的27.3%(9/33)。结论:TH胶栓塞范围与远期疗效密切相关,联合部分脾动脉栓塞和内镜下套扎治疗能明显降低食管胃静脉曲张复发和再出血。

Objective：To analye the factors that effect the prospective efficacy of Percutaneous Transhepatie Varices Embolization on the control of hemorrhage from esophageal and gastric varices. Methods： PTVE was attempted in 192 patients with liver cirrhosis and hemorrhage from esophagus and gastric varices. The a-eyanoacrylate was injected into the entire lower esophageal and periesophageal or paraesophageal varices, the fundus and pericardial vessels. Results：PINE was successfully performed in 188 of 192 patients, providing a procedural success rate of 97.8%. The follow-up of 6 to 64 months with 168 patients was carried out after embolization. According to the distribution of injected a-eyanoacrylate, 3 types of varieeal embolizafion were defined, i. e, esophagogastrie obliteration （n = 82）, gastric obliteration （n= 67）, and main left gastric vein obliteration （n = 19）. Partial splenic embolization was attempted in 135 patients after PrVE. Endoscopic varieeal ligation or endoscopic injection sclerotherapy was carried out in 42 patients during the follow-up period. The total relapso rate was 15.5% （26/168）, with the rate being significantly lower in patients with esophagogastrie obliteration than in patients with main left gastrie vein obliteration or with gastric obliteration （ P 〈 0.01301, log-rank test）. Total rebloedlng rote was 12.5% （21/168）, with the rate 58.1% （11/19） in patients with left gastric vein obliteration, 3.7% （3/82） in patients with esophagogastric obliteration and 10.4% （7/67） in patients with gastric obliteration, 2.4% （1/42）in patients connected with therapeutic endoscopy, 8.9 % （12/135） in patients connected with partial splenic embolization, obviously lower than single PTVE27.3 % （9/33）. Conclusion： This procedure shows PTVE with permanent tissue adhesive cyanoacrylate is safe and effective for the obliteration of gastroesophagueal varices in cirrhotic patients. Combined with partial splenic embolization or endoscopyic therapy Will signkqeanfly reduce the relapse and reblooding rate.