经皮经肝医用胶栓塞治疗肝硬化瘤样胃底静脉曲张临床观察

Efficacy of percutaneous transhepatic variceal embolization with TH glue for large gastric fundal variceal bleeding

目的评价以医用胶为栓塞剂的经皮经肝胃底曲张静脉栓塞术（PTVE）治疗和预防肝硬化患者瘤样胃底静脉曲张破裂出血的临床疗效。方法回顾性分析24例采用医用TH胶完成PTVE治疗的肝硬化胃底静脉曲张破裂出血患者的病例资料，比较治疗前后胃底静脉曲张程度的变化情况，统计术后再出血率及死亡率。结果治疗前24例患者胃底曲张静脉团直径均在20mm以上，治疗后胃底静脉曲张程度显著减轻，其中20例（83．3％）曲张静脉团直径减至5mm以下或消失，4例（16．7％）曲张静脉团直径减至5～10mm。在术后1—36个月，平均16．6个月的随访期内，再出血率和病死率分别为12．5％和12．5％，其中1例死于肝癌，另外2例死于慢性肝功能衰竭。结论对于肝硬化瘤样胃底静脉曲张破裂出血的患者，行医用胶为栓塞剂的PTVE治疗具有良好的临床效果。

Objective To investigate the efficacy of percutaneous transhepatic variceal embolization （PTVE） with Cyanoacrylate （TH glue） in treating large gastric fundal variceal bleeding. Methods PTVE was performed on 24 patients with TH glue injected into the main stem of left gastric vein and its fundic branches. The degree of varices in gastric fundus, rebleeding rate and survival rate after the procedure were compared with those before. Results Varices in gastric fundus were all embolized successfully with TH glue. The diameter of varices was reduced to below 5ram or disappeared in 20 patients （83.3%）, and reduced to 5-10ram in the other 4 （ 16. 7% ）. During the follow-up period of 3-36 months（ mean 16. 6 months） ,the rebleeding rate and mortality were 12. 5% （3/24）, and 12. 5% （3/24）, respectively. One patient died of liver cancer, and two others died of chronic liver failure. Conclusion PTVE with TH glue is of ideal therapeutic effect to block the feeding veins of large gastric fundal varices.