胃冠状静脉TH胶栓塞加脾切除术治疗门静脉高压症食管胃底曲张静脉破裂出血  

The treatment of portal hypertension with stomach coronary vein TH glue embolism plus lienectomy

作　　者：逯云山[1] 张雪峰[1] 宗修锟[1] 曲化远[1] 陈源光[1] 王希泽[1] 那延立[1] 张树渤[1] 

机构地区：[1]沈阳军区总医院普通外科,沈阳110016

出　　处：《临床外科杂志》2004年第7期405-406,共2页Journal of Clinical Surgery

摘　　要：目的　探讨胃冠状静脉TH胶栓塞加脾切除术治疗门静脉高压症食管胃底曲张静脉破裂出血的效果。方法　采用α 氰基丙烯酸正辛脂 (含显影剂的TH胶 )对 10 6例门静脉高压症引起食管胃底静脉曲张的患者行胃冠状静脉栓塞加脾切除术。结果　急诊栓塞 15例 ,出血立即停止 ,止血率 10 0 %。异位栓塞 3例 ( 2 .83 % )。手术死亡 2例 ( 1.89% )。术后胃黏膜糜烂、溃疡出血4例 ( 3 .77% ) ,经保守治疗治愈。随访 92例 ( 86.79% ) ,术前有出血史者 5 4例 ,其中 6例 ( 11.11% )再出血 ,预防性手术 3 8例中有 2例 ( 5 .2 6% )出血。 92例无一例肝性脑病。结论　该术式较分流术简便、创伤小、止血效果好 ,再出血率低 ,适应证宽。Objective To study the therapeutic effect of stomach coronary vein TH glue embolism plus lienectomy in the treatment of portal hypertension.Methods 106 cases of portal hypertension with esophago-fundus of stomach varicosis were treated by using α-cyanogen acrylic (omni-developer with TH glue) embolism plus lienectomy.Results Fifteen cases were subjected to acute embolism and bleeding were stopped immediately with hemostasia rate being 100%.Three cases received dysttopy embolism(2.83%).Two cases were died during operation (1.89 %).After operation 4 cases were suffered from erosion of gastric mucosa and ulcer bleeding(3.77%),and cured by conservative treatment.Among the 92 cases subject to the follow-up(86.79%),54 cases had preoperative bleeding and 6 cases(11.11%) had postoperative bleeding.Two cases were suffered from bleeding in 38 cases undergoing prophylactic operation(5.26%).No hepatic coma occurred in 92 cases.Conclusion This operation has the advantages of simple,less trauma,satisfactory hemostasia effect,lower rebleeding rate and broader adaptation over the bypass operation.

关 键 词：门静脉高压症 出血 TH胶 胃冠状静脉栓塞术 

分 类 号：R657.34[医药卫生—外科学]