胃冠状静脉栓塞联合部分脾栓塞治疗食管静脉曲张出血和脾功能亢进症：与外科手术比较  

Percutaneous transhepatic embolization of gastroesophageal varices combined with partial splenic embolization for variceal bleeding and hypersplenism:a comparison with surgery

作　　者：宫卫东[1] 薛克[2] 褚延魁[3] 王青[3] 阳威[1] 权辉[2] 杨鹏[4] 王执民[1] 吴智群[1] 

机构地区：[1]第四军医大学唐都医院介入放射科,西安710038 [2]宝鸡中心医院介入放射科 [3]第四军医大学唐都医院普外科,西安710038 [4]第四军医大学统计学教研室

出　　处：《介入放射学杂志》2010年第2期105-109,共5页Journal of Interventional Radiology

基　　金：陕西省社会发展攻关计划(2009K17-05);唐都医院2009新技术资助课题

摘　　要：目的评价经皮经肝胃冠状静脉栓塞(PEGV)联合部分脾栓塞(PSE)双介入治疗中、晚期肝硬化食管静脉曲张及门脉高压的效果。方法50例肝硬化患者,随机分为双介入组和外科手术组,分别行PEGV联合PSE治疗和断流术。随访24个月,行胃镜、腹部超声、肝功能和凝血系列检查,并统计分析结果。结果入组50例患者均顺利进行相应治疗。在双介入组,术前白细胞、血小板计数分别是(2.33±0.65)×109/L和(3.63±1.05)×109/L,术后24个月分别是(7.98±3.0)×109/L和(163±91)×109/L(P<0.05);术前门静脉直径(1.47±0.25)cm,术后24个月为(1.31±0.23)cm(P<0.05);术后24个月11例患者食管静脉曲张程度自Ⅲ级降至Ⅱ级,6例患者自Ⅱ级降至Ⅰ级。1例患者出现门脉血栓。术后24个月再出血率为16%(4/25),3例患者因再出血死亡,1例患者死于肝功能衰竭。在外科治疗组,术前白细胞和血小板计数分别是(2.2±0.60)×109/L和(41.0±12.5)×109/L,术后24个月分别为(9.3±2.56)×109/L和(321±12.5)×109/L(P<0.05);术前门静脉直径(1.43±0.22)cm,术后24个月(1.28±0.18)cm(P<0.05);术后24个月13例患者食管静脉曲张程度自Ⅲ级降至Ⅱ级,7例患者自Ⅱ级降至Ⅰ级。4例患者术后出现门脉血栓。术后24个月再出血率为20%(5/25),2例患者因再出血死亡,2例患者死于术后肝功能衰竭。结论PGEV+PSE双介入治疗在控制再出血以及提高血细胞数量方面显示出较大优势。Objective To evaluate the efficacy of the combination of percutaneous transhepatic embolization of gastroesophageal varices（PEGV） and partial splenic embolization（PSE） for the treatment of variceal bleeding.Methods Fifty patients with cirrhosis who fit in with the requirements of the study were randomly divided into dual-interventional group and surgical group.The patients in dual-interventional group were treated with PEGV together with PSE, and the patients in surgery group were treated with Hassab＇s operation.After the procedure all the patients in two groups were followed up periodically.The endoscopy, B ultrasonography, liver function tests and hematologic examinations were performed 24 months after the therapy, and the results were statistically analyzed.Results Fifty patients were enrolled in this study.The procedures of embolization and surgery were successful in all patients.In dual-interventional group, the white blood cell and platelet counts were（2.33 ± 0.65） × 109/ L and（3.63 ± 1.05） × 109/ L respectively before the treatment and were（7.98 ± 3.0） × 109/ L and（163 ± 91） × 109/ L respectively 24 months after the treatment（P 0.05）.The diameter of the portal vein was（1.47 ± 0.25） cm before the treatment and was（1.31 ± 0.23） cm 24 months after the treatment（P 0.05）.The severity of esophageal varices decreased from grade Ⅲ to lower grade II in 11 patients, and from grade II to lower grade I in 6 patients 24 months after procedure.Portal thrombosis occurred in 1 case.The recurrent bleeding rate was 16%（4 / 25） 24 months after treatment.Three patients died of the recurrent bleeding, one patient died of hepatic failure.In surgical group, the white blood cell and platelet counts were（2.2 ± 0.60） × 109/ L and（41 ± 12.5） × 109/ L before treatment, and were（9.3 ± 2.56） × 109/ L and（321 ± 12.5） × 109/ L 24 months after treatment（P 0.05）.The diameter of the portal vein was（1.43 ± 0.22） cm before the treatment and was（1.28 �

关 键 词：食管静脉曲张 脾功能亢进 PGEV PSE 肝硬化 

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