门静脉高压症栓塞治疗前、后门静脉压力变化及其临床意义  

Changes of portal pressure before and after interventional embolization with α-cyanoacrylate alkyl for portal hypertension and their clinical significance

作　　者：杜君彦[1] 吴伟[1] 卢立杰[1] 李成安[1] 宋丽[1] 朱丽明[1] 潘杰[1] 

机构地区：[1]温州市第二人民医院消化科,325000

出　　处：《中华消化杂志》2009年第2期82-85,共4页Chinese Journal of Digestion

摘　　要：目的观察门静脉高压症（PHT）出血患者食管胃底静脉丛应用α-氰基丙烯酸烷基酯（TH胶）栓塞前、后门静脉系统压力动态变化，分析其与消化道出血的关系及预测再出血风险。方法35例食管胃底静脉曲张破裂出血患者，其中25例行食管胃底静脉丛TH胶栓塞，10例行食管胃底静脉丛TH胶栓塞＋部分脾动脉栓塞（PSE）。比较术前、术后门静脉主干、肠系膜上静脉、脾静脉压力变化；观察患者术前、术后肝功能变化；观察手术并发症并对患者进行术后随访3～18个月。结果35例患者均成功止血。食管胃底静脉丛栓塞术后门静脉主干静脉压为（37．45±5．11）cmH2O（1cmH2O=0．098kPa），较术前明显升高[（32．54±5．23）cmH2O，P〈0．01]；术后肠系膜上静脉压为（34．33±4．68）cmH2O，较术前升高[（31．46±4．35）cmH2O，P〈0．05]。10例经食管胃底静脉丛栓塞＋PSE治疗后，患者门静脉主干、肠系膜上静脉和脾静脉压力均较术前明显降低[分别为（28．70±4．58）cmH2O比（32．68±4．89）cmH2O、（28．03±4．12）cmH2O比（31．46±4．35）cmH2O和（28．81±5．12）cmH2O比（32．89±4．79）cmH2O P值均〈0．05]。食管胃底静脉丛栓塞术后3周患者血清白蛋白为（34．57±6．84）g／L，较栓塞前高[（30．45±5．78）g／L，P〈0．05]。术后少量患者出现发热、腹水，经对症治疗后好转。治疗3个月后胃镜显示食管静脉曲张明显减轻。结论食管胃底曲张静脉栓塞对食管胃底静脉曲张急症出血治疗有效，且对肝细胞功能恢复有一定效果，但有增加消化道再出血风险。食管胃底曲张静脉栓塞＋PSE对降低门脉压力及治疗食管胃底静脉曲张出血有效，但不利于肝细胞功能恢复，有增加腹水的风险。Objective To study the changes of portal vein pressure before and after interventional emholization with α-cyanoacrylate alkyl and their clinical significance. Methods Thirty five patients with esophageal-gastric variceal bleeding were included. Esophageal-gastric fundal varices were embolized with a-cyanoacrylate alkyl in 35 patients, and 10 of them were treated with combination of partial splenic emblization. Portal pressure was measured directly before and after interventional embolization. The patients were followed up for 3-18 months. The changes of the liver functions and complications after the embolization were observed. Results All bleeding were controlled successfully. The main portal pressure in those who received variceal embolization only increased significantly from （32.54±5.23） cm H2O （1 cm H2O=0. 098 kPa） to （37.45±5.11） cm H2O; superior mesenteric vein pressure increased from （31.46±4.35） cmH2O to （34.33±4.68）cm H2O; and the level of serum albumin raised from （30.45±5.78） g/L to （34.57±6.84） g/L 3 weeks after embolization. Whereas the main portal pressure in those who received both variceal and partial splenic embolizations, decreased significantly from （32. 68 ± 4. 89 ） cm H2O to （28. 70± 4. 58） cm H2O; superior mesenteric vein pressure decreased from （31.46±4.35） cm H2O to （28.03±4.12） cm H2O; and splenic vein pressure decreased from （32.89±4.79） cm H2O to （28.81±5. 12） cm H2O. Conclusions Esophageal-gastric variceal embolization is effective for variceal bleeding. The increase of main portal pressure after embolization may be benefit for liver function, while the rise of superior mesenteric vein pressure may increase the risk of portal hypertensive gastrointestinal re-bleeding. Esophageal-gastric variceal embolization combined with partial splenic embolization may reduce the incidence of portal hypertension and gastrointestinal re-bleeding, but will increase the risk of ascites.

关 键 词：高血压 门静脉 食管和胃底静脉曲张 栓塞 治疗性 

分 类 号：R686[医药卫生—骨科学]