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首页> 中文期刊> 《胃肠病学》 >经皮经肝食管胃底曲张静脉栓塞术联合部分脾栓塞术治疗肝硬化食管胃底静脉曲张破裂出血疗效观察

经皮经肝食管胃底曲张静脉栓塞术联合部分脾栓塞术治疗肝硬化食管胃底静脉曲张破裂出血疗效观察

         
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摘要

Background:Esophagogastric variceal bleeding is a severe and commonly seen complication of portal hypertension in patients with liver cirrhosis. Prevention of rebleeding remains an important issue in the management of patients suffered from the disease. Aims:To evaluate the efficacy and safety of percutaneous transhepatic variceal embolization(PTVE) combined with partial splenic embolization(PSE)for treatment of esophagogastric variceal bleeding in patients with liver cirrhosis. Methods:Ten liver cirrhosis patients with esophagogastric variceal bleeding were prospectively selected and treated by PTVE combined with PSE. The blood flow of portal system was measured by Doppler ultrasonography pre- and post-operatively;meanwhile peripheral blood cells were counted. A 1-2-year follow-up was carried out and the rebleeding and procedure-related complications were recorded. Results:The postoperative inner diameter of main portal vein,as well as the blood flow velocity of main portal vein and splenic vein were significantly reduced as compared with those before operation(P < 0. 05). Three months after operation,the peripheral white blood cell and platelet were still significantly higher than those before operation(P < 0. 05). During 1-year follow-up,rebleeding appeared in 2 patients,one of them was found having main portal vein thrombosis developed,and was treated by endoscopic esophageal variceal ligation because the gastric varices was not as evident as ever. The rebleeding rate and incidence of portal system thrombosis after the PTVE-PSE procedure was 20. 0% and 10. 0%,respectively. Conclusions:PTVE combined with PSE seemed efficient for alleviating portal hypertension,and might be recommended as a safe and effective interventional therapy for liver cirrhosis patients with esophagogastric variceal bleeding.%背景：食管胃底静脉曲张破裂出血是肝硬化门静脉高压常见且严重的并发症，再出血的预防是该病的治疗重点。目的：评价经皮经肝食管胃底曲张静脉栓塞术（ PTVE）联合部分脾栓塞术（PSE）治疗肝硬化食管胃底静脉曲张破裂出血的疗效和安全性。方法：前瞻性选择10例肝硬化食管胃底静脉曲张破裂出血患者行 PTVE 联合 PSE术，术前、术后行门静脉系统多普勒超声和血常规检查，记录超声血流变化和外周血细胞变化情况。术后随访1~2年，观察再出血和并发症发生情况。结果：PTVE 联合 PSE 术后，患者门静脉主干较术前明显变细，门静脉主干和脾静脉血流速度减慢，术后3个月外周血白细胞和血小板计数仍高于术前，差异均有统计学意义（ P <0.05）。术后1年内2例患者发生再出血，再出血率为20.0%，其中1例复查见门静脉主干血栓形成，发生率为10.0%。该例患者术后胃底静脉曲张基本消失，予内镜下食管曲张静脉套扎治疗后未再复发。结论：PTVE 联合 PSE 术能有效降低门静脉系统压力，是治疗肝硬化食管胃底静脉曲张破裂出血安全、有效的介入治疗方法。

著录项

  • 来源
    《胃肠病学》 |2016年第4期|197-201|共5页
  • 作者

    陈翔; 马鋆; 陈胜良; 李金辉; 许建荣; 程杰军; 张庆; 吴华伟; 严琦; 周孝雯; 曾帅;

  • 作者单位

    上海交通大学医学院附属仁济医院南院消化内科1 201112;

    上海交通大学医学院附属仁济医院放射科2;

    上海交通大学医学院附属仁济医院南院消化内科1 201112;

    上海交通大学医学院附属仁济医院南院消化内科1 201112;

    上海交通大学医学院附属仁济医院放射科2;

    上海交通大学医学院附属仁济医院放射科2;

    上海交通大学医学院附属仁济医院放射科2;

    上海交通大学医学院附属仁济医院放射科2;

    上海交通大学医学院附属仁济医院放射科2;

    上海交通大学医学院附属仁济医院放射科2;

    上海交通大学医学院附属仁济医院放射科2;

  • 原文格式 PDF
  • 正文语种 chi
  • 中图分类
  • 关键词

    肝硬化; 门静脉高压; 食管和胃静脉曲张; 出血; 栓塞,治疗性;

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