经皮肝穿刺胃冠状静脉栓塞术治疗肝硬化合并门静脉高压症的临床应用

目的：探讨经皮肝穿刺食管胃底静脉栓塞术治疗肝硬化门静脉高压食管胃底静脉曲张破裂出血的临床应用。方法：自2009年起,我科对15例肝硬化门静脉高压食管胃底静脉曲张患者采用经皮肝穿刺胃底食管静脉栓塞或联合脾动脉部分栓塞术预防和控制上消化道出血。结果：经皮肝穿刺食管胃底静脉栓塞手术成功率100%,止血率达100%。术后死亡1例,分析原因为急性肺动脉栓塞,术后11例患者出现低热症状,5~7 d后缓解,部分患者术后出现轻度腹痛症状,对症止痛治疗后症状逐渐缓解。除1例患者术后考虑为急性肺栓塞死亡外,未出现肝脏出血、感染、门静脉血栓、肝功能衰竭等并发症。14例患者随访4~10个月,再发消化道出血1例,因肝肿瘤进展死亡4例。结论：经皮肝穿刺胃冠状静脉栓塞技术是一种微创、有效的方法。但是术者在术前及术中需重视对患者血流动力学改变的分析,术中注意观察患者有无大的分流道的存在,并选择合适的栓塞材料。

Clinical application of percutaneous transhepatic variceal embolization in treating liver cirrhosis patients with portal hypertension

Objective：To study the clinical application of percutaneous transhepatic variceal embolization（PTVE） in the treatment of gastric esophageal varices rupture caused by liver cirrhosis with portal hypertension. Methods： Since 2009,15 cases of gastric esophageal varices with liver cirrhosis and portal hypertension were treated by PTVE for prevention and control of upper gastrointestinal bleeding. Results： The success rate of the interventional technique was 100%. One patient died the day after the procedure with acute pulmonary embolism,11 patients had postoperative low fever symptoms in 5 ~ 7days,some patients had mild symptoms of abdominal pain removed by pain killers. No liver bleeding,infection,portal vein thrombosis,liver failure and other serious complications were observed. In addition to one death,other 14 patients were followed up for 4 to 10 months,recurrent gastrointestinal bleeding occurred in 1 case,4 patients died due to liver tumor progression. Conclusion： The PTVE is a minimally invasive and effective method in treating the gastric esophageal varices caused by liver cirrhosis. The operators need to analyze the hemodynamic changes preoperatively and observe the presence of large shunts or not during the procedure and select the appropriate the embolic material carefully.