介入栓塞治疗肝硬化上消化道出血的临床研究

Clinical Study of Upper Gastrointestinal Bleeding Using Transcatheter Embolization for Liver Cirrhosis

目的评价应用经皮经肝食管胃曲张静脉栓塞术(PTVE)联合部分脾动脉栓塞(PSE)在治疗肝硬化门脉高压并上消化道出血的有效性及安全性。方法2006年1月-2008年12月在桂东人民医院住院的患者32例肝硬化门静脉高压合并食管胃曲张静脉破裂致上消化道出血患者,均采用以5%鱼肝油酸钠(或无水乙醇)和弹簧钢圈为栓塞剂行食管胃静脉栓塞术联合以明胶海绵颗粒为栓塞剂行部分脾动脉栓塞术治疗。结果32例食管胃曲张静脉超选择插管栓塞后均成功止血。术后1周27例患者胃镜复查显示食管胃曲张静脉完全消失,4例明显改善。其中1例患者因全身状况差,术后第7天出现肝性脑病死亡。术中及术后未出现重大手术并发症。31例患者术后得到随访,随访6～24个月,再出血3例,死亡2例。结论经皮经肝食管胃曲张静脉栓塞术治疗肝硬化门脉高压所致的上消化道出血疗效好、操作安全,加用部分性脾动脉栓塞术可降低门静脉压力,提高了单纯性食管胃曲张静脉栓塞术的疗效。

Objective To evaluate effectiveness and safety of the percutaneous transhepatic esophageal and gastric varicose vein embolization（PTVE） combined with partial splenic artery embolization（PSE） in the treatment of portal hypertension and upper gastrointestinal bleeding.Methods From January 2006 to December 2008,our hospital had 32 patients hospitalized with cirrhosis causing portal hypertention and esophageal varices contributing to upper gastrointestinal hemorrhage who treated by both 5% morrhuate sodium（or anhydrous ethanol） and spring steel ring for the embolization of esophageal gastric vein and using gelatin sponge particles as embolic material for partial splenic artery embolization.Results 32 cases of esophageal and gastric varices after superselective embolization were stopped bleeding successfully.One week later,27 cases checked by endoscopic inspection showed the entire disappearance of esophageal and gastric varices in 4 cases improved significantly.Of which one patient was in poor condition due to the body,died in hepatic encephalopathy after7 days.Complications of major surgery in intraoperative and postoperative did not appear.31 patients were followed up 6 to 24 months,bleeding occurred again in 3 cases,2 dead.Conclusion Percutaneous transhepatic esophageal and gastric varicose vein embolization for portal hypertension duing to upper gastrointestinal bleeding was efficient,safe operation,and using of partial splenic artery embolization can reduce the portal pressure,increased simple esophageal and gastric at end of the efficacy of variceal embolization.