分阶段联合介入治疗门静脉高压症的临床研究

Clinical study of combined interventional treatment of portal hypertension

目的:探讨分阶段联合介入术治疗门静脉高压症并发食管胃底静脉曲张出血和脾功能亢进的临床疗效。方法:回顾病例资料,分阶段联合介入术(PTVE+分阶段PSE)治疗25例肝硬化门脉高压症并发食管胃底静脉曲张出血和脾功能亢进患者,分析治疗前后内镜下食管胃底曲张静脉变化、血常规、肝功能、再出血情况、术后并发症发生率等。结果:共12例急诊止血,术后急诊止血率100%;术后曲张静脉均消失或明显减轻,治疗后6个月和12个月食管静脉曲张变化情况与治疗前相比,明显好转(P<0.05)。术后白细胞、血小板明显上升,治疗后3、6、12个月分别与治疗前相比,均明显好转(P<0.05);术后白蛋白明显上升,总胆红素下降,治疗后6、12个月分别与治疗前相比,明显好转(P<0.05)。术后并发症:大部分患者仅出现中低度发热;患者疼痛的程度轻、持续时间短。结论:本研究初步认为,分阶段联合介入术能有效治疗食管胃底静脉曲张出血和脾功能亢进,术后并发症少,安全、有效。

Objective： To explore the clinical effect of percutaneous transhepatic variceal embolization,（PTVE） on gastroesphageal variceal bleeding,combined with partial splenic embolization（PSE） on hypersplenism in the treatment of portal hypertension complications.Methods： Review the cases,25 patients with portal hypertension complicated with esophageal varices bleeding and hypersplenism were treated with combined interventional treatment（PTVE ＋ PSE）.And endoscopic gastricesophageal variceal changes,routine blood test,liver function,rebleeding rate,as well as postoperative complication rate were analyzed in these patients before and after the treatment.Results： A total of 12 cases of acute bleeding,hemostasis rate was 100% after emergency combined interventional treatment,and varices disappeared or significantly reduced.Compared with those before treatment,esophageal variceal significantly improved（P 0.05）.after treatment for 6 months and 12 months,and postoperative white blood cells,platelets were significantly improved（P 0.05） in 3,6,12 months after treatment;Albumin increased,total bilirubin decreased after 6,12 months＇ treatment.Postoperative complications： Most patients appear only in the low-grade fever;the extent of pain in patients is light within a short duration.Conclusion： According to this study,PTVE combined with PSE is safe,reasonable and effective for gastroesophageal varices and hypersplenism with fewer postoperative complications.