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目的观察胃冠状静脉栓塞加脾动脉栓塞治疗食管静脉曲张出血的疗效。方法收集我院20例因肝硬化、门静脉高压导致食管静脉曲张出血患者,采用双介入治疗的方法。首先用经皮经肝穿刺门静脉逆行造影,并通过选择性插管胃冠状静脉和胃短静脉,栓塞曲张的食管静脉,控制出血;然后择期采用Seldinger技术行脾动脉部分栓塞术,以降低门静脉压力。结果2例年轻患者术后4年未再发生食管静脉出血;3例患者术后3年未发生食管静脉出血;6例患者术后2年内未发生食管静脉曲张及出血;4例患者术后2年内偶发食管静脉出血,但与术前相比出血量明显减少,且出血间隔时间大大延长;3例因肝癌1年内死亡,但死亡前未再发生食管静脉出血;2例因经皮经肝穿刺门静脉失败而放弃胃冠状静脉栓塞。止血成功率90%(18/20),所有患者脾功能亢进症状明显改善。结论胃冠状静脉及脾动脉栓塞治疗食管静脉曲张,不但可有效控制出血,防止新的侧支循环血管形成,还可以降低门静脉压力,改善脾功能亢进,是一种有效的非手术止血方法。
Objective To observe the curative effect of gastric coronary vein embolization plus splenic arterial embolization in the treatment of esophageal variceal bleeding. Methods Twenty patients with esophageal variceal bleeding due to cirrhosis and portal hypertension were collected and treated by double interventional therapy. First, percutaneous transhepatic portal vein retrograde angiography and selective cannulation of gastric coronary and gastric short-venous catheter, variceal esophageal vein to control bleeding; and then use Seldinger technique of partial splenic artery embolization to reduce portal pressure . Results No esophageal venous hemorrhage occurred in 2 young patients 4 years after operation. No esophageal venous hemorrhage occurred in 3 patients 3 years after operation. Esophageal varices and hemorrhage were not observed in 2 patients 2 years after operation. During the year, occasional esophageal bleeding, but compared with preoperative bleeding decreased significantly, and the bleeding interval greatly extended; 3 cases of liver cancer died within 1 year, but no esophageal bleeding occurred before death; 2 cases of percutaneous transhepatic puncture Portal vein failure to give up gastric coronary vein thrombosis. Hemostatic success rate of 90% (18/20), all patients with hypersplenism significantly improved. Conclusion Gastric-coronary vein and splenic arterial embolization in the treatment of esophageal varices not only can effectively control bleeding, prevent the formation of new collateral circulation, but also can reduce portal pressure and improve hypersplenism, which is an effective non-surgical method of hemostasis.