介入断流术在门静脉高压症致上消化道出血治疗中的临床应用  

INTERVENTION DEVASCULARIZATION IN PORTAL HYPERTENSION INDUCED UPPER GASTROINTESTINAL BLEEDING IN CLINICAL TREATMENT

作　　者：孙青龙 董重谋 王玉凤 黄锐 薛辉 付雪峰 

机构地区：[1]牡丹江林业中心医院放射介入科,黑龙江牡丹江157000

出　　处：《牡丹江医学院学报》2012年第1期26-30,共5页Journal of Mudanjiang Medical University

摘　　要：目的:探讨经皮肝穿刺胃冠状静脉、胃短静脉栓塞术(GCVE)联合部分脾动脉栓塞术(PSAE)在门静脉高压症致上消化道出血治疗中的临床应用价值。方法:2004-01～2011-12我科共收治肝硬化门静脉高压合并急性食管胃底静脉曲张破裂出血患者40例。其中27例患者为消化内科经食管静脉套扎及硬化治疗内科对症治疗后再次出血,13例患者急诊行介入断流术。40例患者中A组25例行经皮肝穿刺胃冠状静脉、胃短静脉栓塞术后,病情稳定后再次行经股动脉穿刺部分脾动脉栓塞术。B组15例单纯行经皮肝穿刺胃冠状静脉、胃短静脉栓塞术。术前、术后分别采用多普勒超声检查门静脉侧支循环情况,对两组进行比较。结果 40例患者曲张出血静脉全部得到栓塞,A组25例患者门静脉管径变小,流速减低,流量下降,奇静脉内径变小,血流量下降,血流速度减低;脾功能亢进症状得到缓解。B组15例患者门静脉管径、血流速、血流量无明显改变,奇静脉内径变小,血流量下降,血流速度减低。40例患者胃冠状静脉超选择插管、栓塞成功。胃短静脉超选择栓塞成功95%。术后随访6～18个月,40例患者出血静脉完全栓塞,其中B组有2例患者2个月后再次出血,再次栓塞后无再出血。结论:经皮肝穿刺胃冠状静脉、胃短静脉栓塞术(GCVE)联合部分脾动脉栓塞术(PSAE)在门静脉高压症致上消化道出血治疗中操作简单,创伤小、止血效果肯定,在急诊止血方面更具有优势,尤其在肝功能较差难以耐受外科分流及断流手术的患者止血治疗中更具有临床应用价值。Objective：T0 investigate percutaneous gastric coronary vein, short gastric vein embolization combined with partial splen- ic artery embolization in portal hypertension induced upper gastrointestinal bleeding in the clinical application of treatment. Method： January 2004 - December 2011 I sections were treated with portal hypertension with acute esophageal variceal bleeding in 40 patients. Of which 27 patients for the Department of Gastroenterology, transesophageal ligation and sclerotherapy of symptomatic medical treatment again after bleeding, 13 patients emergency hne devascularization. A group of 40 patients in 25 routine percutaneous coronary gastric vein, short gastric vein embolization in a stable condition again after passing through the femoral artery partial splenic artery em- bolization. B group, 15 cases of simple percutaneous transhepatic gastric coronary vein, short gastric vein thrombosis. Preoperative and postoperative Doppler ultrasound were used portal collateral circulation of the two groups were compared. Results：All 40 patients received embolization of varicose veins, A group of 25 patients with portal vein diameter becomes smaller, reducing the flow rate, flow down, azygos vein diameter smaller decline in blood flow, blood flow velocity reduction; hyporsplenism symptoms have been alleviated. Group B, 15 patients portal vein diameter, flow velocity, no significant changes in blood flow, azygos vein diameter smaller decline in blood flow, blood flow velocity reduction. 40 patients of gastric coronary vein superselective catheterization, embolization was success- ful. Ultra - short gastric vein embolization successful 95%. Patients were followed up 6 - 18 months, 40 patients were completely hem- orrhagic venous thrombosis, including group B 2 patients bleeding again after 2 months, again without re - bleeding after embolization. Conclusion ：Percutaneous coronary gastric vein, short gastric vein embolization combined with partial splenic embolization in portal hypertension caused by the t

关 键 词：门静脉高压症 上消化道出血 脾功能亢进 介入治疗 栓塞 

分 类 号：R81[医药卫生—放射医学]