TH胶栓塞联合门体静脉小分流治疗肝硬化门脉高压食管胃底静脉曲张出血  

Effect of TH Glue Embolization combined with TIPS in the treatment of portal hypertension combined with gastroesophageal varices bleeding

作　　者：李曙晖[1] 盖伟[1] 靳西凤[1] 崔梅[1] 柴同海[1] 刘春安[1] 

机构地区：[1]山东济宁医学院附属滕州市中心人民医院消化内科,山东滕州277500

出　　处：《胃肠病学和肝病学杂志》2011年第2期145-148,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探讨应用TH胶栓塞联合门体静脉小分流治疗门脉高压食管胃底曲张静脉曲张破裂出血中的应用价值。方法入选41例门静脉高压症并食管胃底静脉曲张的患者,其中21例行TH胶栓塞联合门体静脉小分流术(A组),另外20例患者行经皮经肝食管胃底曲张静脉栓塞术(PTVE)联合部分性脾栓塞(PSE)(B组),对比两组患者肝功能、白细胞、血小板改变、食管胃底曲张静脉消失率、再出血率、肝性脑病发生率及门静脉自由压(free portal pressure,FPP)变化。结果 A组曲张静脉消失率、总有效率均高于B组(P<0.05),再出血率、肝性脑病发生率均低于B组(P<0.05),术后门静脉压力亦明显低于B组(P<0.01)。两组术后白细胞及血小板、白蛋白较术前明显升高,差异有统计学意义(P<0.01),两组之间也存在显著统计学差异(P<0.01)。结论以TH胶栓塞联合门体静脉小分流治疗门静脉高压症食管胃底静脉曲张安全、有效、并发症少,值得临床应用与推广。Objective To explore the clinical efficacy of fixed TH glue（a cyanoacrylate） embolization combined with TIPS in the treatment of portal hypertension combined with gastroesophageal varices bleeding.Methods A total of 41 cases of portal hypertension combined with gastroesophageal varices bleeding were divided into two groups： 21 patients treated with TH glue embolization combined with transjugular intrahepatic Portosystemic shunt（TIPS）（group A） and 20 patients treated with percutaneous transhepatic variceal embolization（PTVE） combined with partial splenic embolization（PSE）（group B）.The incidence of rebleeding,disappearance rate of esophageal variceal,the improvement of splenemagly and the occurring rate of hepatic encephalopathy were observed in two groups.Free portal pressure（FPP） in pre-and post-treatment were measured in all cases.Results All procedures and operations were successful.The rate of variceal disappearance and the total effective rate were significantly higher in group A than those in group B.The recurrent bleeding rate and the incidence of hepatic encephalopathy were lower in group A than those in group B（P0.05）.And the statistical difference was observed in FPP in the two groups before and after therapy（P0.01）.The number of white blood cells and platelet were obviously improved after treatment in the two groups（P0.01）.Conclusion Percutaneous transhepatic fixed TH glue embolization combined with TIPS is safe,reasonable and effective in the treatment of portal hypertension combined with gastroesophageal varices.

关 键 词：TH胶 经颈内静脉肝内门体分流术 经皮经肝食管胃底曲张静脉栓塞术 部分性脾栓塞 

分 类 号：R575.21[医药卫生—消化系统]