经皮肝穿刺胃曲张静脉栓塞术联合或不联合部分脾动脉栓塞术治疗急性食管胃底曲张静脉破裂出血临床观察  

Percutaneous transhepatic variceal embolization or together with partial splenic embolization for acute esophagogastric bleeding due to rupture of varicose veins: a clinical observation

作　　者：潘峰[1] 周国锋[1] 梁斌[1] 郑传胜[1] 冯敢生[1] PAN Feng, ZHOU Guofeng, LIANG Bin, ZHENG Chuansheng, FENG Gansheng(Department of Radiology, Affiliated Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province 430022, Chin)

机构地区：[1]华中科技大学同济医学院附属协和医院放射科、分子影像湖北省重点实验室,武汉430022

出　　处：《介入放射学杂志》2018年第4期316-321,共6页Journal of Interventional Radiology

摘　　要：目的观察比较经皮肝穿刺胃曲张静脉栓塞术(PTVE)联合或不联合部分脾动脉栓塞术(PSE)治疗急性食管胃底曲张静脉破裂出血的临床效果及预后。方法回顾性分析2010年1月至2017年1月采用单纯PTVE或PTVE联合PSE治疗的56例急性活动性食管胃底曲张静脉破裂出血患者临床资料,其中PTVE组22例、PTVE联合PSE组34例。结果术后所有患者活动性上消化道出血完全停止。PTVE联合PSE组白细胞、血小板水平升高显著高于PTVE组(P=0.002,P=0.032)。Log-Rank分析表明两组无事件生存时间(EFS)差异无统计学意义(χ~2=1.571,P=0.210),Cox回归分析表明Child-Pugh评分与再发出血显著相关(HR=1.296,95%CI=1.130~1.488,P<0.001)。结论 PTVE及PTVE联合PSE两种介入手术均可有效地治疗食管胃底曲张静脉破裂活动性出血,两者远期出血率差异无统计学意义,但PTVE联合PSE可显著改善患者脾功能亢进表现。Child-Pugh评分增高是术后再发出血的危险因素。Objective To compare the clinical effect and prognosis of percutaneous transhepatic varieeal embolization （PTVE） plus partial splenic embolization （PSE） with those of pure PTVE in treating acute esophagogastrie bleeding due to rupture of varicose veins. Results After the procedure, the active esophagogastric varices bleeding completely stopped in all patients. The white blood cell （WBC） count and platelet （PLT） count in PTVE＋PSE group were strikingly increased, and the increase was significantly higher than that in PTVE group （P=0.002, P=0.032）. Log-Rank analysis showed that the difference in event-free survival （EFS） time between the two groups was not statistically significant （χ^2=1.571, P=0.210）, and Cox regression analysis revealed that a close correlation existed between Child-Pugh score and the incidence of recurrent bleeding （HR=1.296, 95%CI=1.130-1.488, P〈0.001）. Conclusion For the treatment of active esophagogastric bleeding due to rupture of varicose veins, both PTVE and PTVE ＋PSE are effective. No statistically significant difference in the incidence of long-term bleeding exists between the two therapies, although PTVE＋PSE therapy can remarkably improve symptoms of hypersplenism. High Child-Pugh score is a risk factor for postoperative recurrent bleeding.

关 键 词：肝硬化 食管胃底静脉曲张 出血 介入治疗 

分 类 号：R575.2[医药卫生—消化系统]