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目的探讨经皮穿脾食管胃底静脉栓塞术(PTSVE)在治疗血吸虫病肝硬化上消化道出血中的应用价值。方法以血吸虫病肝硬化门脉高压合并食管胃底静脉曲张破裂出血患者16例(均为食管静脉套扎及硬化治疗术后再次出血患者)为研究对象,其中男12例,女4例。所有病例在X线透视引导下,实施PTSVE术。术后观察手术成功率、并发症发生率,术后1月复查CT,比较患者治疗前后静脉曲张程度。结果 14例(87.50%)患者PTSVE术取得成功,均获有效止血;2例(12.50%)失败;1例术后1周出现腹腔出血。术后1月复查CT,经评估显示患者食道静脉(P<0.001)、食道旁静脉(P<0.001)和胃底静脉(P<0.001)曲张程度均较治疗前明显降低。结论 PTSVE治疗血吸虫病上消化道出血是安全有效的方法,该方法特别适合肝硬化严重,肝裂明显增宽,门静脉主干甚至分支裸露者。
Objective To investigate the value of percutaneous transpectal esophageal and gastric variceal embolization (PTSVE) in the treatment of upper gastrointestinal hemorrhage caused by schistosomiasis cirrhosis. Methods Thirteen patients (12 males and 4 females) were studied with schistosomiasis cirrhosis and portal hypertension combined with esophageal and gastric variceal bleeding in patients with esophageal variceal bleeding after esophageal ligation and sclerotherapy. All cases under the guidance of X-ray, the implementation of PTSVE surgery. After operation, the success rate of operation and complication rate were observed. CT was reviewed in January after operation. The degree of varicose vein before and after treatment was compared. Results Fourteen patients (87.50%) were successfully treated with PTSVE. All patients received effective hemostasis. Two patients (12.50%) failed and one patient developed intraperitoneal hemorrhage one week after operation. CT was reviewed at 1 month after operation, and the esophageal (P <0.001), paraesophageal (P <0.001) and gastric fundus (P <0.001) varices were significantly lower than those before treatment. Conclusions PTSVE is a safe and effective method for the treatment of upper gastrointestinal bleeding in schistosomiasis. This method is particularly suitable for patients with severe cirrhosis, obvious hepatic fissure and portal vein trunk even branch bare.