联合介入与外科手术预防肝硬化胃食管静脉出血的对照研究  

A comparative study of combining interventional embolization and surgery in prevention of gastroesophageal varices rebleeding

作　　者：刘春安[1] 柴同海[1] 王静[1] 李曙晖[1] 杜荣莲[1] 俞景奎[2] 周焕明[1] 张春清[3] 

机构地区：[1]山东省滕州市中心人民医院消化科,277500 [2]山东省滕州市中心人民医院普外科,277500 [3]山东省立医院消化科

出　　处：《中华消化杂志》2007年第10期654-657,共4页Chinese Journal of Digestion

基　　金：山东省医药卫生科技发展计划资助项目(2003 151)

摘　　要：目的探讨胃底静脉栓塞联合部分性脾动脉栓塞预防肝硬化食管胃底曲张静脉破裂出血的有效性。方法将125例肝硬化门脉高压患者随机分为胃底静脉栓塞联合部分性脾动脉栓塞组(A组,60例)和胃底静脉断流加脾切除组(B组,65例)分别进行治疗,对比两组治疗前后内镜下食管胃底曲张静脉变化、血清ALT、总胆红索水平、再出血率、术后并发症发生率及术后死亡率等。结果治疗后1个月A、B两组共112例患者接受胃镜复查,两组食管胃底曲张静脉消失率(分别为90.9%和87.7%)差异无统计学意义(P>0.05)。治疗后1周,B组血清ALT、总胆红素水平(分别为156 U/L和86μmol/L)显著高于A组(分别为65 U/L和34μmol/L)及治疗前(分别为51 U/L和45μmol/L)。A、B两组曲张静脉破裂再出血率分别为7.3%和12.3%,差异无统计学意义(P>0.05),但术后并发症发生率(分别为3.3%和18.5%)、Child-Pugh C级患者死亡率(分别为1/15和6/11)及急性胃黏膜出血发生率(分别为20.0%和45.6%)差异有统计学意义(P<0.05)。结论胃底静脉栓塞联合部分性脾动脉栓塞预防肝硬化食管胃底静脉曲张破裂出血的近期疗效优于胃底静脉断流加脾切除术。该技术对患者创伤小、并发症少、手术死亡率低,特别对于肝功能较差、不能耐受外科手术的患者是较为理想的选择。Objective To investigate the efficacy of percutaneous transhepatic varices embolization （PTVE） of gastric fundal varices combined with partial splenic artery embolization（PSE） in prevention of rebleeding of gastroesophageal varices in patients with liver cirrhosis. Methods One hundred and twenty five cirrhotic patients with variceal bleeding were assigned to treat either with PTVE plus PSE （group A, n=60） or portalazygous devascularization（PAD） plus splenectomy（group B, n=65）. The gastric fundal varice was monitored by endoscopy. Serum ALT, total bilirubin levels were examined before and after treatment. The rebleeding rate, complications and the motality in two groups were compared. Results One hundred and twelve patients received endocoscopy examination one month after the treatment. The gastroesophageal varices disappeared in 90. 9% of patients in group A and 87.7% of patients in group B （P 〉 0.05）. One week after the treatment, serum ALT and total bilirubin levels in group B（156 U/L and 86 μmol/L, respectively） were significantly higher than those in group A（65 U/L 34 μmol/L, respectively） and those before treatment（51 U/L and 45 μmol/L, respectively）. There was no significant difference in varieeaL rebLeeding between two groups（P 〉 0.05）. However the postoperative complication, mortality in patients with Child-Pugh C cirrhosis and acute gastric mucosal bleeding were significantly higher in group B（18. 5%, 6/11 and 45. 6%, respectively） than those in group A （3.3%, 1/15 and 20. 0%, respectively）. Conclusion The PTVE plus PSE is superior to PAD plus splenectomy in preventing variceal rebleeding in a short-time, which is more suitable to patients with severe liver disease.

关 键 词：肝硬化 胃肠出血 食管和胃静脉曲张 栓塞 治疗性 

分 类 号：R575.2[医药卫生—消化系统] R657.34[医药卫生—内科学]