内镜套扎联合部分脾栓塞术治疗门脉高压症的并发症分析

Complications of combined endoscopic variceal ligation and partial splenic embolization for cirrhotic patients with portal hypertension

目的探讨内镜套扎(EVL)联合部分脾栓塞术(PSE)治疗门脉高压症的并发症发生因素及对策,提高该方法的安全性。方法112例肝硬化失代偿期患者,根据治疗方法分为三组,单纯EVL组(A组)37例,单纯PSE组(B组)35例,EVL联合PSE组(C组)40例。定期随访,比较A、C两组静脉曲张闭塞情况、再出血率;B、C二组外周血象变化;三组术后并发症发生率。结果A、C组食管静脉曲张均已完全闭塞,A组再出血率18.9%,C组未见再出血。B、C两组病例白细胞与血小板术后1周和2周均有显著升高(P<0.05),血红蛋白的浓度则无明显变化。与EVL有关的轻微咽痛或胸骨后疼痛A组占81.1%,C组占80.0%。在PSE治疗后的患者中,脾塞后综合征在B组占85.7%,C组占87.5%;腹水在B组占42.9%,C组占65.0%;脾脓肿在B组占17.1%,C组占17.5%。结论EVL术后并发症轻微,病人易于接受;PSE术后并发症病情严重,需要临床治疗,其预后与围手术期处理有关。

Objective To explore the causes of the complications of endoscopic variceal ligation（EVL） combined with partial splenic embolization（PSE）for cirrhotic patients with portal hypertension, and thereby increasing the safety of the operation. Methods One hundred and twelve cirrhotic patients with portal hyperten- sion were divided into three groups according to their therapeutics： group A, 37 cases, treated with EVL; group B, 35 cases, treated with PSE; group C, 40 cases, treated with EVL combined with PSE. All cases were fol- lowed up, the situation of variceal disappearance and rebleeding were compared between group A and C, pe- ripheral blood cell counts were compared between group B and C, complications after operation were also compared among three groups. Results The varices disappeared in both group A and C, rebleeding rate was 18.9% in group A, and no rebleeding occurred in group C. Peripheral blood cell count showed both leukocytes and platelets were significantly improved in first and second week after operations （P 〈 0.05）, but the hemoglobin showed no diffrence. A mild sore throat and substernal pain after EVL were found in 81.1% of patients in group A, 80.0% in group C; post-embolization syndrome was 85.7% in group B,87.5% in group C; ascites was 42.9% in group B, 65.0% in group C; splenic abscess wasl7.1% in group B, 17.5% in group C. Conclusions The complications of EVL were mild and easily accepted by patients, but complications of PSE were serious.