经皮经肝TH胶灌注栓塞术与内镜下注射TH胶术治疗食管胃底静脉曲张的对照研究

Comparison of TH glue perfusing embolization through PTVE and TH glue perfusing embolization through endoscope

目的比较α-氰基丙烯酸正辛酯(TH胶)作为栓塞材料行经皮肝穿刺门静脉胃冠状静脉栓塞术(percutaneous transhepatic varices embolization,PTVE)和内镜下食管胃底静脉注射TH胶术的远期疗效及可行性。方法将150例门脉高压食管静脉曲张破裂出血患者随机分为2组,分别行经皮肝TH胶灌注胃冠状静脉栓塞术联合部分脾脏栓塞术和内镜下食管胃底静脉注射TH胶术。结果所有患者均手术成功,止血率达100%。随访3年,行PTVE的患者食管胃底静脉曲张再出血率为25.00%,而内镜下食管胃底静脉注射TH胶术的患者的再出血率为53.24%。结论 PTVE手术安全,创伤小,止血率高,再出血率低,是治疗门脉高压并食道胃底静脉曲张的理想方法。

Objective To investigate the feasibility and efficacy of pereutaneous transhepatic varices （PTVE） embo lization of gastroesophageal varices combined with partial splenic emboliaztion （PSE） in gastroesophageal varices bleed ing. Methods 150 cases of portal hypertension and rupture of esophago-fundus of stomach varices were divided into two groups. One group was TH glue perfusing embolization through PTVE ＋ PSE partial splenic embolization, the other group was TH glue perfusing embolization by endoscope. Results This operation was successfull in all patients, hemostasia rate was 100%. Among three years of the follow-up, the group＇ s rebleeding rate with PTVE was 25.00% , and the oth er group was 53.24%. Conclusion PTVE is safer, less trauma, higher hemostasia rate, lower rebleeding rate, so it is a rational treatment for portal hypertension and esophago-fundus of stomach varicosity.