急诊介入栓塞治疗对急性重度静脉曲张上消化道出血的临床价值研究

目的 探讨急诊介入栓塞治疗对于急性重度静脉曲张上消化道出血（ASVUGIB）患者的临床价值。方法 收集直接或补救介入治疗的48例ASVUGIB患者数据。按急诊介入原因分为直接介入治疗组（40例）及补救性介入治疗组（8例）, 对经DSA明确造影剂外溢的直接出血征象患者行经皮经肝/经脾门静脉造影+曲张静脉栓塞术+ 经颈静脉肝内门体分流术（TIPS）;对经DSA未发现明确出血征象的患者行经皮经肝/经脾门静脉造影+曲张静脉栓塞术, 术中视门静脉压力情况行经TIPS术;对于存在门-体异常分流道患者, 行球囊阻断逆行经静脉闭塞术（BRTO）+ TIPS, 治疗后随访6个月, 观察患者的临床预后。结果 直接介入治疗组患者的出血病变血管检出率为78%, 治疗有效率为78%;7 d、30 d、3个月、6个月内再出血率分别为23%、45%、45%、45%;7 d内、30 d内、3个月内、6个月内病死率分别为15%、28%、28%、28%。补救性介入治疗组患者DSA出血病变血管检出率为6/8, 治疗有效率为6/8;7 d、30 d、3个月、6个月内再出血率分别为1/8、4/8、4/8、4/8;7 d内、30 d内、3个月内、6个月内病死率分别为1/8、3/8、3/8、3/8。介入治疗后患者转氨酶、白蛋白、总胆红素和凝血功能指标均比治疗前好转（P均< 0.05）, Child-Pugh评分及终末期肝病模型评分均低于治疗前（P均< 0.05）。结论 ASVUGIB是临床常见的危急症, 早发现、早干预、早治疗可改善患者预后, 介入栓塞治疗可作为存在胃镜治疗相对禁忌或胃镜治疗失败的ASVUGIB患者的治疗选择。

Clinical value of emergency interventional therapy for acute severe variceal upper gastrointestinal bleeding

Objective To evaluate the clinical value of emergency interventional therapy for patients with acute severe variceal upper gastrointestinal bleeding （ASVUGIB）. Methods Clinical data of 48 ASVUGIB patients who received direct or remedial interventional therapy were collected retrospectively. They were divided into the direct interventional therapy group （n = 40） and remedial interventional therapy group （n = 8）. For patients with bleeding signs of contrast medium leakage in angiography, percutaneous transhepatic/transsplenic portal venography + variceal embolization + transjugular intrahepatic portosystemic shunt （TIPS） were performed; for patients without clear signs of bleeding, percutaneous transhepatic/transsplenic portal venography+variceal embolization were performed and TIPS was performed according to the pressure of the portal vein during the operation; for patients with portosystemic shunt, balloon-occluded retrograde transvenous obliteration （BRTO） and TIPS were performed. The patients were followed up for 6 months to observe the clinical prognosis. Results The diagnostic rate of vessels with bleeding lesions in the direct interventional therapy group was 78%, the effective rate was 78%; the rebleeding rates within 7 d, 30 d, 3 months and 6 months were 23%, 45%, 45% and 45%, respectively; the mortality rates within 7 d, 30 d, 3 months and 6 months were 15%, 28%, 28% and 28%, respectively. The diagnostic rate of vessels with bleeding lesions by angiography was 75% in the remedial interventional therapy group, the effective rate was 6/8; the rebleeding rates within 7 d, 30 d, 3 months and 6 months were 2/8, 4/8, 4/8 and 4/8, respectively; the mortality rates within 7 d, 30 d, 3 months and 6 months were 1/8, 3/8, 3/8 and 3/8, respectively. The liver functions （transaminase, albumin and bilirubin） and coagulation function of patients after interventional therapy were improved compared with those before treatment （all P < 0.05）. Child-Pugh and MELD scores were decreased compared with those before treatment （both P < 0.05）. Conclusions ASVUGIB is a common severe acute disease in clinical practice. Early diagnosis, intervention and treatment of ASVUGIB can significantly improve the prognosis of patients. Interventional therapy can be used as treatment for ASVUGIB patients who have contraindications or failures in gastroscopic therapy.