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目的 探讨胃冠状静脉、胃短静脉栓塞术对胃底静脉曲张出血治疗的价值。方法 32 例肝硬化并食管胃底静脉曲张出血经内镜下套扎、硬化治疗后仍有出血的患者,经皮经肝穿刺行胃冠状静脉、胃短静脉栓塞治疗。栓塞剂主要为无水乙醇、钢圈和明胶海绵。均行 1 次栓塞治疗,并经 3~11 个月随访,胃镜复查。结果 29例复查胃镜,其中21例(72.4%)胃底曲张静脉完全消失,8 例(27.6%)胃底曲张静脉明显减轻,无红色征及糜烂。随访期内有 1 例(3.1%)因门脉高压性胃炎致黏膜糜烂出血。未发现明显并发症。结论 经皮经肝穿刺行胃冠状静脉、胃短静脉栓塞治疗具有消除胃底静脉曲张,并可预防出血的作用。
Objective To investigate the value of gastric coronary vein and short-leg vein embolization in the treatment of gastric variceal hemorrhage. Methods Thirty-two patients with cirrhosis and esophageal variceal hemorrhage underwent endoscopic ligation and sclerosis after hemorrhage were treated by percutaneous transhepatic gastric puncture and gastric venous thrombosis. Embolic agents are mainly ethanol, steel ring and gelatin sponge. All patients underwent an embolization treatment and were followed up for 3 to 11 months with endoscopy. Results Twenty-nine patients underwent gastroscopy. Twenty-one patients (72.4%) had complete disappearance of gastric fundus varicose veins, and 8 patients (27.6%) had significantly reduced gastric varices without red signs and erosion. During the follow-up period, 1 case (3.1%) had mucosal erosion and hemorrhage due to portal hypertensive gastritis. No obvious complications were found. Conclusion Percutaneous transhepatic puncture of gastric coronary vein and gastric short-leg vein embolization has the effect of eliminating gastric varices and preventing bleeding.