经脾穿刺组织胶栓塞胃冠状静脉联合脾栓塞治疗上消化道出血的疗效分析  

Analysis of curative effect of gastric coronary vein embolization combined with transsplenic puncture splenic embolization in the treatment of upper gastrointestinal hemorrhage

作　　者：杜鲲 胡小波[2] 李明省[2] 尹君 熊臣 邓绍雄 DU Kun;HU Xiao-bo;LI Ming-xing;YIN Jun;XIONG Chen;DENG Shao-xiong(Department of Inte went ionol Radiology,Xinyangg Central Hospital,Xinyarig Heium 464000,China;Intervention Office of the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]河南省信阳中心医院介入科,河南信阳464000 [2]郑州大学第一附属医院介入科,河南郑州450052

出　　处：《中国临床医学影像杂志》2021年第2期112-116,共5页Journal of China Clinic Medical Imaging

摘　　要：目的:探讨经脾穿刺应用组织胶栓塞胃冠状静脉(GCVE)联合部分脾动脉栓塞(PSE)治疗上消化道急性出血的安全性及有效性。方法:回顾性分析125例行GCVE结合PSE术治疗消化道出血的临床资料,比较手术前后的门静脉系统流体力学变化、食管-胃底静脉曲张改善程度、术后即刻止血疗效、再发出血率及并发症情况。结果:125例消化道出血患者均手术成功,无围手术期死亡病例,门脉压力由手术前的(35.60±3.15) cm H_(2)O降至手术后的(25.37±2.36) cm H_2O,术前门脉内径(16.63±2.27) mm,门脉流速(0.95±0.21) cm/s、血流量(14.43±1.87) L/min,术后4周分别为(11.77±2.00) mm、(0.62±0.10) cm/s、(7.40±0.89) L/min,手术前后对比有统计学差异(P<0.05)。胃镜随访显示,食管-胃底静脉曲张程度存在不同程度改善的共91例,改善率为72.8%。截止至随访时再发消化道出血6例,均经内科治疗后有效止血。结论:GCVE联合PSE治疗上消化道出血可有效降低门脉压力,即刻止血高效,中远期食管-胃底静脉曲张有不同程度改善,是一种治疗门脉高压所致上消化道急性出血的有效方法。Objective:To explore the safety and effectiveness of gastric coronary vein embolization(GCVE)combined with partial splenic artery embolization(PSE)via splenic puncture in the treatment of acute upper gastrointestinal hemorrhage.Methods:We analyzed retrospectively and follow-up to the clinical data of upper gastrointestinal hemorrhage patients by PSE and GCVE,including portal venous flow on pre-operation and post-operation,the change of esophageal and gastric varices,hemostatic effect,rebleeding rate and the postoperative complication were compared.Results:All of 125 patients with gastrointestinal hemorrhage were successfully operated without perioperative death.The portal vein pressure decreased from(35.60±3.15)cm H2 O before surgery to(25.37±2.36)cm H2 O after surgery(P<0.05).The internal diameter of the portal vein was(16.63±2.27)mm before the operation,the portal vein velocity was(0.95±0.21)cm/s,the blood flow was(14.43±1.87)L/min,and 4 weeks after surgery were(11.77±2.00)mm,(0.62±0.10)cm/s,(7.40±0.89)L/min respectively.There is a statistical difference in the comparison before and after the operation(P<0.05).Gastroscopy follow-up showed that there were 91 cases with varied degrees of improvement in the degree of esophageal-gastric varices,the improvement rate was 72.8%.By the time of follow-up,6 cases of gastrointestinal hemorrhage occurred again,all of which were effectively stopped after medical treatment.Conclusion:GCVE combined with PSE in the treatment of upper gastrointestinal hemorrhage can effectively reduce portal pressure,stop bleeding immediately,and improve mid-and long-term esophageal-gastric varices to varied degrees.It is an effective method for the treatment of acute upper gastrointestinal hemorrhage caused by portal hypertension.

关 键 词：上胃肠道 出血 栓塞 治疗性 放射学 介入性 

分 类 号：R573.2[医药卫生—消化系统] R815[医药卫生—内科学]