经皮肝穿刺胃底食管曲张静脉栓塞术治疗上消化道出血临床探讨

Clininal Investigation of Percutaneous Transhepatic Variceal Embolization for the Treatment of Acute Upper Gastrointestinal Bleeding

目的探讨经皮肝穿刺门静脉行胃底食管曲张静脉栓塞(Percutaneous Transhepatic Variceal Embolization,PTVE)治疗肝硬化食管静脉曲张上消化道出血的临床疗效。方法回顾性分析本院2010年8月～2015年8月收治的76例肝硬化食管胃底静脉曲张破裂出血患者临床资料。行经皮肝穿刺或经皮经脾穿刺门静脉栓塞胃底食管曲张静脉,然后即刻造影复查曲张静脉的栓塞情况。结果 74例患者采用经皮经肝穿刺途径,2例患者采用经皮经脾穿刺途径获得成功,所有患者栓塞术后脾静脉或门静脉造影显示胃底、食管曲张静脉完全闭塞,76例患者均得到有效止血(止血率100%)。术后随访1～30个月,中位随访时间16个月。15例患者术后1～12个月发生再出血,但出血量情况较上次出血明显减少,经再次弹簧圈栓塞胃底曲张静脉后出血得到控制。结论 PTVE治疗肝硬化食管静脉曲张上消化道出血是安全有效的方法,具有确切的疗效。

Objective To evaluate the effect of percutaneous transhepatic variceal embolization （PTVE） of acute upper gastrointestinal bleeding in cirrhotic patients of varicose veins. Methods The clinical data of 76 patients with acute upper gastrointestinal bleeding in cirrhotic patients of varicose veins, who were treated at author＇ s hospital during August 2010 to August 2015, were retrospectively analyzed. Percutaneous transhepatic or percutaneous splenic variceal embolization way were performed in 76 cases, then angiography were used to know the effect of embolization therapy. Results 74 patients were used percutaneous transhepatic way, 2 patients were used percutaneous splenic way, splenic vein or portal vein angiography showed complete occlusion of the fundus and esophageal varices after embolization. It stoped the bleeding after the PTVE in all 76 patients, effective hemostasis （hemostasis rate was 100%） in all 76 patients. The patients were followed up for 1 to 30 months （a median period of 16 months）. Variceal bleeding recurred in fifteen cases in 1 to 15 months, but the amount of bleeding was significantly lower than that of the last hemorrhage, and the hemorrhage was controlled after the embolization of the gastric fundus varicose vein. Conclusion PTVE is a safe and effective treatment for acute upper gastrointestinal bleeding in cirrhotic patients of varicose veins.