部分脾动脉栓塞术联合普萘洛尔预防肝硬化食管胃底静脉曲张再出血的疗效评价  

Effect of partial splenic embolization combined with propranolol in prevention of gastroesophageal variceal rebleeding

作　　者：郑三菊[1] 李敏[1] 占国清[2] 

机构地区：[1]湖北医药学院附属人民医院供应室,湖北十堰442000 [2]湖北医药学院附属人民医院肝病科,湖北十堰442000

出　　处：《临床消化病杂志》2016年第5期303-307,共5页Chinese Journal of Clinical Gastroenterology

摘　　要：[目的]评价部分脾动脉栓塞术(PSE)联合普萘洛尔预防食管胃底静脉曲张再出血的临床疗效。[方法]35例近期食管胃底静脉曲张破裂出血患者,被随机分为普萘洛尔组(对照组,17例)、PSE+普萘洛尔组(联合组,18例),比较2组治疗后1、3个月外周血象变化,脾脏厚度、门静脉内径、脾静脉内径变化,治疗后3、6及12个月不同时间段的再出血率,观察并发症和预后情况。[结果]与治疗前比较,联合组治疗后1、3个月外周血WBC和PLT明显升高(P<0.01),治疗后3个月脾脏厚度、门静脉内径及脾静脉内径明显缩小(P<0.05);治疗后3个月外周血WBC和PLT较治疗后1个月明显下降(P<0.01)。与对照组比较,联合组治疗后1、3个月外周血WBC和PLT明显升高(P<0.01),治疗后3个月脾脏厚度、门静脉内径及脾静脉内径明显缩小(P<0.05),治疗后12个月内再出血率明显降低(P<0.05)。2组均出现了相关并发症,但未发现严重的并发症,观察期间2组病死率比较差异无统计学意义。[结论]PSE联合普萘洛尔预防食管胃底静脉曲张再出血疗效较单独使用普萘洛尔更佳。[Objective] To evaluate the effect of partial splenic embolization（PSE）combined with propranolol in prevention of gastroesophageal variceal rebleeding. [Methods]Thirty-five patients with recent gastroesophageal variceal bleeding were randomly divided into propranolol group（17 cases）and PSE combined with propranolol group（18 cases）. The peripheral blood change,thickness of the spleen,splenic vein （SV）and portal vein（PV）diameter change after treatment 1,3 months,the rebleeding rates after treatment 3,6,12 months,complications and prognosis between the two groups were compared. [Results]Compared with pre-treatment, the peripheral white blood cells and platelet count increased more significantly 1,3 months after treatment（P〈0.01）and spleen thickness,portal vein and splenic vein diameter was reduced more significantly 3 months after treatment（P〈0.05）in PSE combined with propranolol group. Peripheral white blood cells and platelet count decreased more significantly 3 months after treatment than 1 month after treatment（P〈0.01）. Compared with propranolol group,peripheral white blood cells and platelet count increased more significantly 1,3 months after treatment（P〈0. 01）, spleen thickness, portal vein and splenic vein diameter was reduced more significantly 3 months after treatment（P〈0.05）, and rebleeding rate reduced more significantly after treatment 12 months （P〈0.05 ）in PSE combined with propranolol group. The two groups had related complications, but no serious complications were found. There was nosignificant difference in mortality between the two groups during the observation period. [Conclusion]Com- pared with propranolol treatment,PSE combined with propranolol treatment has better effect in prevention of gastroesophageal variceal rebleeding.

关 键 词：食管胃底静脉曲张 部分脾动脉栓塞术 普萘洛尔 再出血 

分 类 号：R575.2[医药卫生—消化系统]