Ultrasound-guided percutaneous,hepatic,portal vein,combined with radiological interventions for the

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Objective To observe the efficacy and safety of percutaneous transhepatic portal and gastric coronary vein embolization and sclerotherapy in the treatment of gastroesophageal varices.Methods Four patients with hepatitis B cirrhosis and portal hypertension were treated with percutaneous transhepatic portal and gastric coronary vein occlusion under the guidance of B-mode ultrasonography for recurrent upper gastrointestinalbleeding in patients with post-hepatitis cirrhosis and portal hypertension.The occlusion methods were gelatin sponge embolization,sclerosing agent or coil therapy.Postoperative reconstruction was performed to observe the development of gastric coronal vein,whether contraction became thinner or not,and the hepatic parenchyma was injected with gelatin sponge mixture.Ultrasound was used to observe the presence of intrahepatic perihepatic hemorrhage and local injection of hemostasis if necessary.Gastroscopy was reexamined 2 weeks after operation to observe esophagogastric varices.Results The esophagogastric varices were found in 6 male patients by gastroscopy before operation.The varices were scattered in the middle and lower esophagus to cardia.The communicating veins were seen in the middle of dentate line,and the red sign was positive.Two weeks after operation,gastroscopy showed that the above esophageal and fundal varices were significantly alleviated and the red sign disappeared.No upper gastrointestinal bleeding was observed for 1,3,6 and 9 months.Two patients had right hemorrhagic pleural effusion,which disappeared completely after thoracic drainage after hemostasis.No severe complications such as fever,pneumothorax and pulmonary embolism occurred.Conclusion Ultrasound guided percutaneous transhepatic portal vein embolization combined with radiotherapy has a lasting and more thorough hemostatic effect and better patient tolerance.The multidisciplinary cooperation of ultrasound and DSA is expected to improve the prevention and treatment of massive upper gastrointestinal bleeding due to rupture of esophageal and gastric varices in portal hypertension.
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