经皮经肝食管胃底曲张静脉栓塞术联合部分脾栓塞术治疗肝硬化食管胃底静脉曲张破裂出血疗效观察

背景:食管胃底静脉曲张破裂出血是肝硬化门静脉高压常见且严重的并发症,再出血的预防是该病的治疗重点。目的:评价经皮经肝食管胃底曲张静脉栓塞术(PTVE)联合部分脾栓塞术(PSE)治疗肝硬化食管胃底静脉曲张破裂出血的疗效和安全性。方法:前瞻性选择10例肝硬化食管胃底静脉曲张破裂出血患者行PTVE联合PSE术,术前、术后行门静脉系统多普勒超声和血常规检查,记录超声血流变化和外周血细胞变化情况。术后随访1~2年,观察再出血和并发症发生情况。结果:PTVE联合PSE术后,患者门静脉主干较术前明显变细,门静脉主干和脾静脉血流速度减慢,术后3个月外周血白细胞和血小板计数仍高于术前,差异均有统计学意义(P0.05)。术后1年内2例患者发生再出血,再出血率为20.0%,其中1例复查见门静脉主干血栓形成,发生率为10.0%。该例患者术后胃底静脉曲张基本消失,予内镜下食管曲张静脉套扎治疗后未再复发。结论:PTVE联合PSE术能有效降低门静脉系统压力,是治疗肝硬化食管胃底静脉曲张破裂出血安全、有效的介入治疗方法。     

经皮经肝曲张静脉栓塞治疗断流术后食管胃底静脉破裂出血的疗效

目的 研究以组织胶为主要栓塞材料,采用经皮经肝曲张静脉栓塞术(PTVE)治疗和预防门奇静脉断流术后食管胃底静脉曲张破裂出血的临床疗效.方法 2006年11月至2008年9月,对22例曾行断流术再发食管胃底静脉曲张破裂出血的患者行PTVE组织胶栓塞(n=10)或内镜下硬化剂(EIS,n=12)治疗,随访两组患者治疗后再出血率、死亡率、治疗前后静脉曲张和肝功能以及PTVE治疗组患者在曲张侧支静脉栓塞前后门静脉压力的变化.结果 ①在平均12.5个月的随访期内,PTVE治疗组患者再出血率和死亡率分别为1/10和0;EIS治疗组随访13.4个月,患者再出血率和死亡率分别为7/12和3/12,两组问差异有统计学意义(P<0.05).②PTVE和EIS治疗均可显著减轻食管和胃底静脉曲张程度.③对有门静脉血栓患者,PTVE联合门静脉球囊成形术,可以改善肝脏门静脉血供.④PTVE和EIS治疗均未加重肝功能损伤.结论 对门奇静脉断流术后食管胃底静脉破裂出血的患者,采用以组织胶为主要栓塞材料的PTVE治疗的疗效优于EIS治疗.     

经皮经肝食管胃底曲张静脉TH胶定位栓塞联合部分性脾栓塞的临床应用

食管胃底静脉曲张破裂出血是肝硬化严重并发症之一,首次出血死亡率高达40％,传统的经皮经肝食管胃底曲张静脉栓塞术(PTVE),不能永久性栓塞曲张静脉,术后再通率高。我们设计了经皮经肝食管胃底静脉TH胶定位栓塞技术,达到了急症止血、预防再出血的目的。联合部分性脾栓塞(PSE),减少脾脏血流量,降低门静脉压力,弥补单纯PTVE后门静脉压力升高的不足,同时缓解了脾功能亢进。     

TH胶栓塞联合门体静脉小分流治疗肝硬化门脉高压食管胃底静脉曲张出血

目的探讨应用TH胶栓塞联合门体静脉小分流治疗门脉高压食管胃底曲张静脉曲张破裂出血中的应用价值。方法入选41例门静脉高压症并食管胃底静脉曲张的患者,其中21例行TH胶栓塞联合门体静脉小分流术（A组）,另外20例患者行经皮经肝食管胃底曲张静脉栓塞术（PTVE）联合部分性脾栓塞（PSE）（B组）,对比两组患者肝功能、白细胞、血小板改变、食管胃底曲张静脉消失率、再出血率、肝性脑病发生率及门静脉自由压（free portal pressure,FPP）变化。结果 A组曲张静脉消失率、总有效率均高于B组（P〈0.05）,再出血率、肝性脑病发生率均低于B组（P〈0.05）,术后门静脉压力亦明显低于B组（P〈0.01）。两组术后白细胞及血小板、白蛋白较术前明显升高,差异有统计学意义（P〈0.01）,两组之间也存在显著统计学差异（P〈0.01）。结论以TH胶栓塞联合门体静脉小分流治疗门静脉高压症食管胃底静脉曲张安全、有效、并发症少,值得临床应用与推广。     

经皮经肝TH胶灌注栓塞术与内镜下注射TH胶术治疗食管胃底静脉曲张的对照研究

目的比较α-氰基丙烯酸正辛酯(TH胶)作为栓塞材料行经皮肝穿刺门静脉胃冠状静脉栓塞术(percutaneous transhepatic varices embolization,PTVE)和内镜下食管胃底静脉注射TH胶术的远期疗效及可行性。方法将150例门脉高压食管静脉曲张破裂出血患者随机分为2组,分别行经皮肝TH胶灌注胃冠状静脉栓塞术联合部分脾脏栓塞术和内镜下食管胃底静脉注射TH胶术。结果所有患者均手术成功,止血率达100%。随访3年,行PTVE的患者食管胃底静脉曲张再出血率为25.00%,而内镜下食管胃底静脉注射TH胶术的患者的再出血率为53.24%。结论 PTVE手术安全,创伤小,止血率高,再出血率低,是治疗门脉高压并食道胃底静脉曲张的理想方法。     

食管胃底静脉栓塞术联合部分脾栓塞术治疗门静脉高压症疗效观察

门静脉高压症是肝硬化的首要并发症，它发生于肝硬化之前，且贯穿于肝硬化始终。它是肝硬化最主要的病理生理变化，常并发消化道出血、脾功能亢进等并发症。其中胃食管曲张静脉破裂出血是门静脉高压症患者的主要死亡原因之一。目前所有的诸多治疗门静脉高压症的方法各有利弊，疗效尚不令人满意，本研究应用双介入术即食管胃底曲张静脉栓塞术(PTVE)联合部分脾栓塞术(PSE)治疗肝硬化门脉高压症所致胃食管曲张静脉破裂出血和脾功能亢进，     

食管胃底曲张静脉栓塞联合部分脾动脉栓塞术

食管胃底曲张静脉破裂出血是肝硬化门静脉高压患者上消化道大出血的主要原因,经皮经肝曲张血管栓塞术(PTVE)和部分脾动脉栓塞术(PSE)是近年来应用于肝硬化门脉高压症介入治疗的新技术。1适应证和禁忌证适应证:食管胃冠状静脉栓塞术主要用于临床保守治疗或内镜下治疗无效的食管胃底静脉破裂出血,治疗主要在出血期进行。禁忌证:有明显出血倾向者或终末期患者。2操作方法直接门静脉造影,显示胃冠状静脉和(或)胃短静脉以及增粗扭曲的食管胃底静脉丛,借助导管导丝进入胃冠状静脉及胃短静脉进行栓塞治疗。先用无水乙醇5～30ml分次推注,再用高压…     

经皮经肝食管胃底静脉栓塞断流术对肝功能的影响

目的探讨食管胃底静脉栓塞术（percutaneous transsplenic variceal embolization PTVE）治疗肝硬化门静脉高压性上消化道出血,对患者肝功能的影响。方法通过经肝经门静脉食管胃底静脉栓塞断流术治疗有食管胃底静脉曲张出血的肝硬化患者36例,对照组30例采用内科保守治疗,随访6个月的肝功能指标、Child-Pugh分级变化和出血复发率,进行对比。结果观察组的肝功能指标：ALB、TBil、PTA和NH3,与对照组对比P值分别为〈0.05、〈0.01、〈0.01和〈0.001;Chind-Pugh分级与对照组对比,P〈0.01,有显著性差异;观察组出血再发率也明显低于对照组,8.33%对26.7%,P〈0.05,两组对比显著性差异。结论食管胃底静脉栓塞断流术不仅能减少门静脉高压性上消化道出血复发率降低,同时能改善肝硬化患者的肝功能状况。     

经皮经肝食管胃底曲张静脉栓塞术联合部分脾栓塞术治疗食管胃底静脉曲张出血

近年来,采用的经皮经肝食管胃底曲张静脉栓塞术(PTVE)联合部分脾栓塞术(PsE)治疗食管胃底静脉曲张破裂出血,取得了较好的临床疗效. 一、资料与方法 1.病例来源:收集本院2007年4月-2008年5月行PTVE联合PSE治疗的肝硬化合并食管胃底静脉曲张出血的患者33例.     

经皮经肝医用胶栓塞治疗肝硬化瘤样胃底静脉曲张临床观察

目的 评价以医用胶为栓塞剂的经皮经肝胃底曲张静脉栓塞术(PTVE)治疗和预防肝硬化患者瘤样胃底静脉曲张破裂出血的临床疗效.方法 回顾性分析24例采用医用TH胶完成PTVE治疗的肝硬化胃底静脉曲张破裂出血患者的病例资料,比较治疗前后胃底静脉曲张程度的变化情况,统计术后再出血率及死亡率.结果 治疗前24例患者胃底曲张静脉团直径均在20 mm以上,治疗后胃底静脉曲张程度显著减轻,其中20例(83.3％)曲张静脉团直径减至5 mm以下或消失,4例(16.7％)曲张静脉团直径减至5 ～10 mm.在术后1～36个月,平均16.6个月的随访期内,再出血率和病死率分别为12.5％和12.5％,其中l例死于肝癌,另外2例死于慢性肝功能衰竭.结论 对于肝硬化瘤样胃底静脉曲张破裂出血的患者,行医用胶为栓塞剂的PTVE治疗具有良好的临床效果.     

Gastric varices

Gastric varices may appear in association with esophageal varices secondary to portal hypertension or as an independent manifestation of splenic vein obstruction. Since gastric varices often manifest as radiologic filling defects in the gastric fundus or cardia, differentiation from tumors and many other diseases becomes imperative. Unfortunately, routine diagnostic procedures may be of limited value. The difficulties in the diagnosis of gastric varices are illustrated with three specific cases. Correct diagnosis is best established with the aid of endoscopy and such special procedures as celiac angiography or splenoportography. With the help of three cases, the characteristics of gastric varices are reviewed and their evaluation and management are outlined.     

Colonic varices

Summary A patient with recurrent gastrointestinal bleeding was found to have varices at the splenic flexure at colonoscopy. Angiography revealed complete occlusion of the splenic vein. Although the patient did not have cirrhosis, he did have a history of pancreatitis which presumably was responsible for the splenic vein thrombosis. This case represents a compartmentalized form of portal hypertension which requires careful endoscopic and radiographic studies for proper evaluation. Successful treatment was accomplished by splenectomy.     

Vulvar varices

Vulval or vulvoperineal varicose veins generally appear in the course of child-bearing under the influence of hormonal impregnation on susceptible terrain. The vulval venous network is drained by the external pudendal veins, collateral with the internal saphenous veins, and by the internal pudendal veins affluent from the internal iliacs. Hormonal influence appears to play a major role in associating estrogen, progesterone, gonadotropin and corticosteroids, which have a lytic action on elastic tissues during motherhood. In the course of pregnancy, functional symptomatology is generally visible from the fifth month. The varices located at the vulva are generally unilateral, and gradually become congestive, appearing as purple protrusions of a soft consistency. After delivery, they are attenuated without usually totally disappearing. Outside pregnancy, clinical manifestations are less frequent and vulvoperineal varices are only revealed by close clinical examination. They are often the causal factor for reflux which, regardless of whether it is associated with incontinence of the saphenous trunks, provokes varicose dilatation of the lower limbs. Differential diagnosis is performed with the post-phlebitic syndrome. Doppler echography allows any participation of the deep venous trunks to be ruled out. Phlebography is reserved for severe angiomatous dilatations of the vulval region. In the non-pregnant patient, treatment consists of sclerotherapy, surgery being reserved for cases refractory to this method. In our direct experience with 386 cases, only 85 females presented isolated vulvoperitoneal varices. Of the 83 patients, treated by sclerotherapy, 63% of the cases have shown no recurrence within the subsequent three years.     

Gallbladder varices

Gallbladder varices are relatively rare ectopic varices in patients with portal hypertension. We present here a case of gallbladder varices accurately diagnosed by color Doppler sonography. A 51-year-old woman was admitted to our unit with recurrent esophageal varices bleeding due to extrahepatic portal vein occlusion after splenectomy. Bleeding was controlled by endoscopic band ligation and esophageal varices were eradicated after the second endoscopic session. Doppler imaging showed the existence of portal cavernoma and gallbladder varices. The close follow-up period after complete eradication of esophageal varices showed no enlargement of varices of the gallbladder or complications related to them. Color Doppler sonography is a valuable noninvasive imaging technique for assessment of portal hemodynamic profile in patients with portal cavernoma as well as useful in detecting gallbladder varices. Preoperative correct diagnosis of gallbladder varices should increase the surgeon's vigilance during biliary tract surgery in patients with portal hypertension in order to avoid hazardous complications.     

Duodenal varices

Bleeding from duodenal varices in portal hypertension may not be recognized, resulting in a delay in diagnosis. Early detection is important as duodenal varices are a potential source of massive hemorrhage. We report two cases with recurrent upper gastrointestinal hemorrhage in whom accurate diagnosis was made only after extensive investigation including repeated endoscopic examination.