门脉高压合并上消化道出血采用PTVE联合PSE手术的效果分析

Analysis of the effect of PTVE combined with PSE on portal hypertension complicated with upper gastrointestinal hemorrhage

目的探讨门脉高压症合并上消化道出血患者经皮经肝食管胃底静脉栓塞(PTVE)联合经皮部分性脾动脉栓塞术(PSE)治疗的效果。方法选取2013年1月至2016年6月两院行急诊手术治疗的89例门脉高压症合并上消化道出血患者作为研究对象,采用随机数字表法将患者分为研究组45例(经肝食管胃底静脉栓塞术+经皮部分性脾动脉栓塞术PTVE+PSE)和对照组44例(采用肝食管胃底静脉栓塞术PTVE治疗),对比两组的止血情况、胃食管静脉曲张程度以及复发率。结果研究组和对照组的止血时间、止血率、输血量比较差异均无统计学意义(P>0.05)。研究组术后3个月的胃食管静脉曲张程度较对照组显著的减轻(P<0.05);研究组术后6个月的再出血率6.67%、术后12个月的再出血率15.56%均显著的低于对照组的34.09%、50.00%(均P<0.05)。术后3个月,研究组的脾静脉淤血指数、脾脏长度、脾脏厚度均低于对照组(P<0.05)。术前,两组的血清白蛋白(ALB)、外周血血小板(PLT)水平差异不具有统计学意义(P>0.05);术后3个月,研究组的血清ALB、外周血PLT水平均高于对照组(P均<0.05)。结论门脉高压症合并上消化道出血患者采用经肝食管胃底静脉栓塞术+经皮部分性脾动脉栓塞术(PTVE+PSE)手术止血效果可靠,远期效果优于单用经肝食管胃底静脉栓塞术(PTVE)手术治疗。

Objective To explore the effect of PTVE combined with PSE in the treatment of portal hypertension with upper gastrointestinal bleeding.Methods Selected the January 2013 to 2016 June in our hospital underwent emergency surgical treatment of 89 cases of portal hypertension complicated with upper digestive tract hemorrhage patients as the research object,the random number table method as the study group 45 cases(percutaneous liver esophageal and gastric fundus vein embolization(PTVE+PSE)and control group(n=44)(produced with PTVE),the hemostasis,gastroesophageal varices,and recurrence rate of the two groups were compared.Results Study group and control group bleeding time,bleeding rate,blood transfusion volume difference had no statistical significance(all P>0.05);3 months after the operation,the study group of esophageal and gastric varices degree than in the control group were significantly reduced(P<0.05);study group after 6 months of re bleeding rate was 6.67%,postoperative 12 months of rebleeding was 15.56%were significantly lower than the control group 34.09%,50.00%(P<0.05);3 months after the operation,the group of spleen vein congestion index,spleen length and thickness of the spleen were lower than in control group(all P<0.05);Before operation,there was no significant difference in serum ALB and peripheral blood PLT counts between the two groups(P>0.05);3 months after operation,the serum ALB and peripheral blood PLT counts in the study group were higher than those in the control group(P<0.05).Conclusion Portal hypertension patients with upper gastrointestinal bleeding in patients with PSE PTVE+surgery to stop bleeding effect is reliable,long-term effect is better than the single use PTVE surgery.