经皮肝穿刺胃冠状及胃短静脉栓塞术治疗胃底静脉曲张出血

目的探讨经皮肝穿胃冠状静脉、胃短静脉栓塞术对胃底静脉曲张长期疗效。方法 67例肝硬化并胃底重度静脉曲张出血的患者,经皮经肝穿刺行胃冠状静脉、胃短静脉栓塞治疗。栓塞剂主要为无水乙醇、钢圈和明胶海绵。均行1次栓塞治疗,并经48～69个月随访,平均60.2个月,胃镜复查。结果随访期间43例(76.8%)胃底曲张静脉完全消失,8例(14.3%)胃底静脉曲张复发、无红色征及糜烂,有3例(5.4%)胃底静脉曲张破裂出血,食管静脉曲张程度无明显变化,而1例(1.8%)因门脉高压性胃炎致黏膜糜烂出血,未发现明显并发症。结论经皮肝穿刺行胃冠状静脉、胃短静脉栓塞治疗具有胃底静脉曲张消失率高,复发率低,长期疗效好。

The effect of percutaneous transhepatic embolization of gastric coronary and short gastric veins on the control of hemorrhage from gastric varices

Objective To study the effect of percutaneous transhepatic embolization of gastric coronary and short veins on the control of hemorrhage from gastric fundal varices. Methods Thirty -two patients with liver cirrhosis and hemorrhage from esophagus and fundal varices, who still had variceal bleeding after endoscopic banding or sclerosing of esophageal varices were included in the study.Gastric coronary and short veins were embolized by percutaneous,transhepatic embolization with absolute alcohol, steel ring, or gelfoam. The follow-up of 60.2 months was carried out after embolization. Results The follow -up endoscopy showed that the varices of gastric fundus disappeared completely in 43 of 56 patients(76.8%), and eleminated partially in 8 (14.3%) patients, recurrence of gastric varices bleeding only in 3 patient (5.4%); no significant changes in esophageal varices and 1 patient (1.8% ) re -bleeding due to portal hypertensive gastropathy during the follow -up period. No obvious complication was found in these patients. Conclusion The varices of gastric fundus could be obliterated by percutaneous, transhepatic embolization of gastric coronary and short gastric veins.