经皮经肝食管胃底曲张静脉栓塞术治疗肝硬化断流术后食管胃底静脉曲张破裂再出血34例分析

Therapeutic effect and advantages of percutaneous transhepatic variceal embolization in treatment of variceal rupture and bleeding after devascularization: an analysis of 34 cases

目的探讨经皮经肝食管胃底曲张静脉栓塞术(PTVE)在肝硬化断流术后并发食管胃底静脉曲张破裂再出血治疗中的应用,评价其治疗效果及优势。方法收集2007年1月-2013年6月响水县人民医院消化内科收治的34例肝硬化断流术后食管胃底静脉曲张破裂再出血患者的临床资料,所有患者均行PTVE,术后定期复查胃镜,观察患者术后疗效、并发症以及再出血情况。结果 34例行PTVE治疗的患者急性期止血良好,有效率97%(33/34);术后2周曲张静脉均消失或明显减轻者29例(85.3%),随访2年食管胃底静脉曲张好转及消失者30例(88.2%);随访的2年内共6例(17.6%)出现上消化道出血。所有病例均未出现明显严重并发症。结论 PTVE治疗肝硬化断流术后静脉曲张再出血患者疗效显著,创伤小,并发症少,可防止新的侧支循环血管形成,是治疗肝硬化断流术后食管胃底静脉曲张破裂再出血的有效方法。

Objective To investigate the application of percutaneous transhepatic variceal embolization （PTVE） in the treatment of rupture and rebleeding in esophageal and gastric varices after devascularization for liver cirrhosis, and to evaluate its therapeutic effect and advantages. Methods The clinical data of 34 patients with rupture and rebleeding in esophageal and gastric varices after devascularization for liver cirrhosis treated in Department of Gastroenterology, Xiangshui People＇s Hospital from January 2007 to June 2013 were collected, ann all pa- tients received PTVE. Regular gastroscopic reexaminations were performed after the surgery, and postoperative outcome, complications, and the condition of rebleeding were observed. Results Acute - stage hemostasis for 34 patients receiving FFVE was good, with a response rate of 97% （33/34） ; at 2 weeks after surgery, varices disappeared or were significantly relieved in 29 patients （85.3 % ）, and after the 2 - year follow - up, 30 patients （ 88.2% ） achieved improvement in or disappearance of esophageal and gastric varices ; during the 2 - year fol- low - up, 6 patients （ 17.6% ） experienced upper gastrointestinal bleeding. No severe complications were observed. Conclusion PTVE has a significant therapeutic effect in the treatment of variceal rebleeding after devascularization for liver cirrhosis, with minimal trauma and few complications, and can prevent the formation of new collateral vessels. Therefore, it is an effective method to treat rupture and rebleeding in esophageal and gastric varices after devascularization for liver cirrhosis.