急诊经皮经肝食管胃底静脉栓塞治疗重度肝硬化消化道出血

Percutaneous transhepatic variceal obliteration in patients with severe hepatic cirrhosis

目的 评价经皮经肝食管胃底静脉栓塞术在重度肝硬化患者急性食管胃底静脉曲张破裂出血中的应用价值。方法 19例食管胃底静脉曲张破裂出血肝硬化患者 ,肝功能评价均为ChildC级 ,行急诊经皮经肝食管胃底静脉栓塞治疗。结果 19例门脉穿刺及曲张静脉栓塞手术均获成功。 18例即刻止血成功 ;1例无效 ,行TIPSS治疗。 1～ 12个月随访期内 ,再出血 14例 ;死亡 15例 ;4例存活。严重合并症 1例 ,为腹腔内出血 ,行开腹探查。结论 对于ChildC级肝硬化食管胃底静脉曲张破裂出血患者 ,急诊条件下经皮经肝食管胃底静脉栓塞术止血效果肯定 ,当TIPSS禁忌时 。

Objective To evaluate the effects of percutaneous transhepatic variceal obliteration in the treatment of acute bleeding from gastroesophageal varices in patients with severe cirrhosis.Methods 19 patients with Child C cirrhosis suffered from active bleeding from gastroesphageal varices. Emergency procechures of percutaneous transhepatic variceal obliteration were performed in all 19 patients. Results Successful catheterization and obliteration of the varices in all of the 19 cases. Active bleeding were controlled in 18 cases with only one failure and TIPSS was performed. During a follow up peroiod ranging from one to 12 months, 14 cases bled recurrently during 3 to 12 months. 15 cases died within the follow up period. 4 cases were alive. Severe complication of intraperitoneal bleeding occurred in 1 case, and laparotomy was performed. Conclusions Percutaneous transhepatic variceal obliteration is effective in controlling acute bleeding from gastroesophageal varices in patients with Child C cirrhosis. It could be used as the first choice treatment method for emergency when TIPSS is contraindicated.