急诊PTVE-PSE治疗门静脉高压症导致的急性消化道大出血的效果观察

Effect of percutaneous transhepatic variceal embolization and partial splenic embolization on acute gastrointestinal hematorrhea caused by portal hypertension

目的探讨经皮经肝食管胃底曲张静脉栓塞术（PTVE）联合部分性脾动脉栓塞术（PSE）治疗门静脉高压症导致的急性消化道大出血的临床效果。方法回顾性分析门静脉高压症所致急性消化道大出血患者124例,其中行急诊PTVE术59例作为对照组,接受急诊PTVE术后进一步行PSE术的65例患者作为观察组。比较两组患者的术后门静脉压力变化情况、住院天数以及并发症发生情况。术后6、12、18个月定期随访了解两组患者的再出血发生情况以及1年病死率。结果两组患者手术前门静脉压无明显差异（t=0.195,P=0.846）,对照组患者术后较术前门静脉压升高（t=-3.195,P=0.002）,观察组患者术后较术前门静脉压明显下降（t=5.182,P〈0.01）。观察组术后住院天数明显多于对照组,差异有统计学意义（t=2.909,P=0.004）;对照组患者术后并发症发生率明显高于观察组,特别是门静脉高压性胃肠道病（对照组13例,观察组4例）以及腹水（观察组23例,对照组6例）的发生例数,差异有统计学意义（χ^2=32.887,P〈0.01）;观察组患者术后6、12、18个月的再出血发生率均明显低于对照组,差异有统计学意义（χ^2=5.740,7.986,19.569;均P〈0.05）;观察组患者随访1年病死率明显低于对照组,差异有统计学意义（χ^2=5.673,P=0.017）。结论 PTVE术序贯PSE术操作相对简单,术中创伤小,同时还能降低门静脉压力并使其保持在较低水平,降低患者术后再出血率,对门静脉高压导致的急性消化道大出血患者具有良好的治疗效果。

Objective To investigate the effect of percutaneous transhepatic variceal embolization(PTVE)combined with partial splenic embolization(PSE)on acute gastrointestinal hematorrhea caused by portal hypertension.Methods One hundred and twenty-four patients with acute gastrointestinal hematorrhea caused by portal hypertension in our hospital from August 2012 to March 2014 were retrospectively analyzed.Fifty-nine patients merely received PTVE in control group,while sixty-five patients received PSE after PTVE in treatment group.Portal venous pressure,postoperative complications,rebleeding rate(6-month,12-month,18-month)and 1-year mortality were compared between the two groups.ResultsCompared to pre-operation,the portal venous pressure significantly increased in control group(t=0.195,P=0.846),but significantly decreased(t=5.182,P<0.01)in treatment group after operation.Comparing with control group,treatment group showed significantly higher postoperative hospital days(t=2.909,P=0.004),and significantly lower postoperative complications,rebleeding rate(6-month,12-month,18-month)and 1-year mortality(χ~2=32.887,P<0.01,χ~2=5.740,7.986,19.569,P<0.05 andχ~2=5.673,P<0.05),respectively.Conclusion Sequential combination therapy of PTVE with PSE brings obvious advantage of easy operation and minimal wound during operation.For patients with acute gastrointestinal hematorrhea caused by portal hypertension,it has not only shown good performance on hemostasis,but also decreased the portal venous pressure and rebleeding rate after operation.