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目的评价应用经皮经肝食管胃曲张静脉栓塞术(PTVE)联合部分脾动脉栓塞(PSE)在治疗肝硬化门脉高压并上消化道出血的有效性及安全性。方法2006年1月-2008年12月在桂东人民医院住院的患者32例肝硬化门静脉高压合并食管胃曲张静脉破裂致上消化道出血患者,均采用以5%鱼肝油酸钠(或无水乙醇)和弹簧钢圈为栓塞剂行食管胃静脉栓塞术联合以明胶海绵颗粒为栓塞剂行部分脾动脉栓塞术治疗。结果32例食管胃曲张静脉超选择插管栓塞后均成功止血。术后1周27例患者胃镜复查显示食管胃曲张静脉完全消失,4例明显改善。其中1例患者因全身状况差,术后第7天出现肝性脑病死亡。术中及术后未出现重大手术并发症。31例患者术后得到随访,随访6～24个月,再出血3例,死亡2例。结论经皮经肝食管胃曲张静脉栓塞术治疗肝硬化门脉高压所致的上消化道出血疗效好、操作安全,加用部分性脾动脉栓塞术可降低门静脉压力,提高了单纯性食管胃曲张静脉栓塞术的疗效。
Objective To evaluate the efficacy and safety of percutaneous transhepatic esophagogastric variceal embolization (PTVE) combined with partial splenic arterial embolization (PSE) in the treatment of portal hypertension and upper gastrointestinal bleeding. Methods From January 2006 to December 2008, 32 patients with portal hypertension in cirrhosis complicated with esophageal variceal bleeding in upper gastrointestinal bleeding were treated with 5% sodium morrhuate (or absolute ethanol ) And spring steel ring for the embolization of esophagogastric gastroesophageal embolization combined with gelatin sponge particles embolization for partial splenic artery embolization. Results 32 cases of esophageal varices were successfully hemostatic after superselective intubation. One week after operation, gastroscopy of 27 patients showed complete disappearance of esophageal varicose veins, 4 cases improved significantly. One of the patients died of hepatic encephalopathy on the 7th day after surgery due to poor general condition. No major operative complications occurred during or after surgery. Thirty-one patients were followed up for 6-24 months, 3 cases were rebleeding and 2 died. Conclusion Percutaneous transhepatic esophagogastric variceal embolization in the treatment of upper gastrointestinal hemorrhage caused by cirrhosis and portal hypertension is safe and safe. Partial splenic arterial embolization can reduce portal vein pressure and improve simple esophageal varices Embolization of the curative effect.