联合介入治疗门静脉高压症及康复护理

Combined Embolization for Treating the Portal Hypertension and Nursing Care

目的 :探索联合应用脾动脉栓塞术和胃冠状静脉栓塞术对肝硬化门脉高压症的临床治疗和护理效果。方法 :4 8例肝硬化门静脉高压症并脾功能亢进患者 ,先后行脾动脉栓塞术和胃冠状静脉栓塞术 ,于术前后均配合整体的护理程序。结果 :4 8例患者手术操作成功 ,与治疗前比较门静脉压力和脾静脉血流量下降 ;内窥镜及食道钡餐显示静脉曲张好转 ;术后 1年随访患者均存活 ,脾功能亢进症状缓解 ,肝功能无明显改变 ,其中 1例术后复发出血。结论 :联合介入断流术对门静脉高压症有明显治疗效果 ,加强术后护理是预防并发症和手术成功的保证.

Objective: To investigate the primary curative and nursing effects of combined application of partial splenic embolization (PSE) with percutaneous transhepatic embolization (PTE) of gastroesophageal varice to treat the portal hypertension patients with post-hepatitis cirrhosis. Methods:Forty-eight cases of portal hypertension complicated with hypersplenism were subjected to PSE andPTE successively. The changes in free portal pressure (FPP) was observed and the portal hemodynamic data were measured by Doppler sonography before and after operation. The condition of gastroesophageal varice and rebleeding were followed up. Results: The surgical operations were successively performed in all patients. After embolization, the FPP was decreased by 3.96±1.84 mmHg, and the quantity of blood flow of splenic vein decreased obviously (P<0.05). The degree of gastroesphageal varice was alleviated under endoscopy or GI barium radiography after the treatment. All patients were alive during one year of follow-up after operation and only one patient rebleeded. The hypersplenism symptom diminished post embolization and the procedure didn't affect the liver function and immune function. Conclusion: The combined embolization could improve the state of hyperdynamic flowing in the splenogastric region and reduce the FPP post embolization to some extent. Therefore, the procedure is simple, safe and effective for treatment of hypersplenism and gastroesphageal hemorrahge, as well as portal hypertensim. To enhance postoperative nursing is an important factor to prevent complications and to ensure success of operation.