生物蛋白胶栓塞治疗门脉高压性上消化道出血30例  

Efficacy of fibrin glue in percutaneous transhepatic obliteration for the management of upper gastrointestinal bleeding in patients with portal hypertension

作　　者：原强[1] 白旭明[1] 程龙[1] 顾星石[1] 靳勇[1] 

机构地区：[1]苏州大学附属第二医院介入科,江苏省苏州市215000

出　　处：《世界华人消化杂志》2012年第34期3397-3402,共6页World Chinese Journal of Digestology

摘　　要：目的:评价生物蛋白胶在经皮经肝食管胃底曲张静脉栓塞术治疗胃底食管静脉曲张破裂出血中的可行性和临床价值.方法:60例肝硬化、食管静脉曲张破裂出血的患者,分为经皮经肝胃底曲张静脉栓塞组(percutaneous transhepatic obliteration,PTO)30例和食管曲张静脉套扎组(esophageal varices ligation,EVL)30例,PTO组是在X线透视下经皮经肝穿刺进入上消化道出血责任血管,用弹簧钢圈和生物蛋白胶栓塞曲张的食管和胃底静脉,比较两组治疗方法的急诊止血率和术后累计无出血率.结果:PTO组中28例门脉穿刺及曲张静脉栓塞手术均获成功,1例造影示为门静脉海绵样变,进入责任血管困难,无法进行栓塞治疗,1例行门静脉造影未见明显胃底曲张静脉,栓塞成功率为96.6%(28/29),其余病例术后48h止血率达100%.EVL组急诊止血率为93.3%(28/30).在12-50mo随访期内的患者中,PTO组再出血10例,EVL组再出血17例,PTO组和EVL组的6mo累计无出血率分别为89.3%vs80%,1年累计无出血率为85.7%vs56.7%,PTO组术后累计无出血率明显高于EVL组(?2=5.314,P<0.05).结论:经皮经肝食管胃底静脉栓塞中应用生物蛋白胶治疗上消化道出血安全有效,创伤小、止血效果肯定,在急诊止血方面更具优势,值得推广应用.AIM： To evaluate the feasibility and clinical value of fibrin glue in percutaneous transhepatic obliteration （PTO） for acute variceal bleeding in patients with cirrhosis. METHODS： Thirty cirrhotic patients with acute variceal bleeding underwent fluoroscopy-guid- ed PTO. Esophageal and/or gastric varices were embolized with fibrin glue and stainless steel coils. The rate of emergency hemostasis and postoperative cumulative non-bleeding rate in patients treated with PTO were compared with those in patients undergoing esophageal varices ligation （EVL）.RESULTS： PTO therapy was technically suc- cessful in 96.6% （28/29） of patients. Cavernous transformation of the portal vein was revealed by portography in one case, and it was difficult to enter the vessel responsible for varices. No obvious varices could be seen by portography in another patient. In the EVL group, the emergen- cy hemostasis rate was 93.3% （28/30）. During a follow-up period of 12-50 too, rebleeding was observed in 10 patients in the PTO group and 17 patients in the EVL group. The 6- and 12-mo cu- mulative non-bleeding rates for the PTO group and the EVL group were 89.3% vs 80% and 85.7% vs 56.7%, respectively. The postoperative cumulative non-bleeding rate for the PTO group was significantly higher than that for the EVL group （x^2 = 5.314, P 〈 0.05）. CONCLUSION： The use of fibrin glue in percu- taneous transhepatic variceal obliteration is a safe, minimally invasive and effective treatment for upper gastrointestinal bleeding and may be the first choice in patients with acute variceal hemorrhage.

关 键 词：肝硬化 门脉高压 出血 食管胃底静脉曲 张 生物蛋白胶 

分 类 号：R575.2[医药卫生—消化系统]