国产组织胶内镜下注射联合套扎治疗食管胃底静脉曲张的临床应用

目的探讨国产组织胶内镜下注射联合套扎治疗食管胃底静脉曲张的临床效果。方法24例食管胃底静脉曲张患者。分三种方法治疗：（1）套扎＋组织胶注射1次完成10例;（2）套扎与组织胶注射分次完成10例;（3）采用组织胶直接注射治疗4例。结果4例活动性出血经治疗均即刻止血,成功率100％,10例套扎＋组织胶注射1次完成者,食管和胃底静脉曲张治疗总有效率100％;10例套扎＋组织胶分次完成者,食管静脉曲张治疗总有效率90％,胃底静脉总有效率80％,两组疗效比较无统计学意义;并发症：总发生率12．5％（3／24）,2例注射完拔针后少许出血,1例术后2周排胶出血,经适当处理均止血。结论国产组织胶注射联合套扎治疗食管胃底静脉曲张和／或出血,近期疗效可靠、操作安全,并发症少而轻。     

介入血管栓塞联合内镜注射硬化治疗食管胃底静脉曲张

【摘要】目的：观察多种介入方法联合应用治疗食管胃底静脉曲张的临床效果。方法：25例食管胃底静脉曲张患者,分别行经皮肝穿冠状静脉栓塞（PTVE）和球囊阻断静脉逆行硬化闭塞胃静脉曲张（BRTO）,并发脾功能亢进者,同时行部分脾动脉栓塞（PSE）。术后对有残留食管静脉曲张的病例行内镜硬化剂注射治疗（EIS）。全部治疗完成后常规临床观察,并定期复查胃镜和CT增强扫描。结果：25例患者,7例行PTVE+PSE; 11例行BRTO,6例行BRTO+PSE,1例BRTO手术失败;术后11例患者接受内镜注射治疗一次,4例患者接受二次注射治疗。3例患者死亡,其中1例于术后2月死于再发出血。结论：多种介入方法联合应用,具有可靠的预防上消化道出血的效果。     

经皮经肝TH胶"三明治"栓塞术治疗食管胃底静脉曲张

目的:介绍经皮经肝TH胶“三明治”栓塞技术在胃冠状静脉栓塞术中的应用。方法:采用经皮经肝TH胶“三明治”定位栓塞胃冠状静脉(必要时联合栓塞胃短和胃后静脉)治疗食管胃底静脉曲张病人43例。27例病人同时行部分脾动脉栓塞;另9例既往己行脾切除 断流术后,仅行TH胶定位栓塞;9例为急症栓塞治疗。结果:①33例成功,成功率92%;②近期效果:术后即刻食管胃底曲张静脉血流消失100%;术后27例复查,食管胃底静脉曲张基本消失16例(59.3%),减轻8例(33.3%),总有效率92.6%;③手术死亡率2.8%,,未发生TH胶异位栓塞;④23例随访3~16个月(平均9.5个月),曲张静脉复发或加重2例(8.7%),再出血1例(4.3%),静脉曲张持续稳定占91.3%。结论:经皮经肝TH胶定位栓塞术操作安全、疗效确切,是食管胃底静脉曲张合理的介入治疗方法。     

经脾穿刺插管栓塞治疗门静脉高压上消化道出血

目的 评价经脾入路栓塞治疗门静脉高压上消化道出血的临床疗效及安全性.方法 20例乙型肝炎后肝硬化患者,均出现门静脉高压性食管胃底静脉曲张破裂出血.8例为右叶巨大肝癌;10例为肝癌合并门静脉癌栓,门静脉主干闭塞;2例为肝硬化并发门静脉主干血栓性闭塞.所有患者采取经脾穿刺,脾静脉插管至胃冠状静脉,用液态栓塞剂加弹簧圈栓塞曲张的食管胃底静脉.结果 18例患者手术成功,2例失败;共栓塞35支胃冠状静脉,栓塞成功患者均获有效止血,未出现并发症.结论 经脾穿刺插管栓塞治疗门静脉高压上消化道出血的方法安全有效,适合于患有巨大肝癌及(或)门静脉主干闭塞等无法采用经皮经肝入路或TIPS栓塞食管胃底静脉曲张的患者.     

TH胶栓塞胃冠状静脉曲张在门静脉高压治疗中的应用

目的:探讨α氰基丙烯酸正辛酯(TH胶)在胃冠状静脉栓塞术联合部分脾脏栓塞术治疗门脉高压胃底食管曲张静脉破裂出血的可行性和疗效。方法:对27例门脉高压胃底食管曲张静脉破裂出血的病人应用TH胶为栓塞剂经皮肝穿行胃冠状静脉栓塞术联合部分脾脏栓塞术。结果:所有患者均手术成功,止血率达100%。1月后,胃镜及钡餐检查,食道静脉曲张消失率为70.4%。随访6~12个月1例因胃粘膜病变出血,余者病情好转或稳定。结论:应用TH胶胃冠状静脉栓塞联合部分脾栓塞手术安全,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理想方法。     

经皮经肝TH胶定位栓塞治疗食管胃底静脉曲张出血的护理

我院消化科自2003年2月-2004年10月开展了经皮经肝TH胶定位栓塞于冠状静脉主干及胃底和贲门的交通支，治疗食管胃底静脉曲张出血取得了较好的中远期效果，现将护理要点报告如下。     

经皮经肝食管胃底静脉曲张栓塞术的临床应用

目的评价经皮经肝食管胃底静脉曲张栓塞术的临床应用价值。方法肝硬化门静脉高压合并食管胃底静脉曲张破裂出血患者30例(24例为食管静脉套扎及硬化治疗术后再次出血；6例为消化道出血未行内镜治疗者)。电视透视下取右腋中线或剑突下方穿刺进入门静脉分支。用弹簧钢圈、无水乙醇和明胶海绵栓塞食管胃底静脉。2例栓塞后门静脉内留置导管-药盒系统行区域性药物灌注治疗。结果30例患者胃冠状静脉超选择插管、栓塞全部成功。胃短静脉超选择插管栓塞成功率90％。27例患者术后得到随访，随访2～18个月。17例患者术后胃镜复查显示胃底曲张静脉完全消失者13例，明显改善者4例。2例于栓塞术后1周、2个月再出血，再次栓塞后无再出血。2例门静脉留置药盒行区域性中西药物灌注者治疗后门静脉压力分别下降10cmH2O(1cmH2O=0．098kPa)和8cmH2O。结论经皮经肝食管胃底静脉曲张栓塞术创伤小、止血效果肯定，在急诊止血方面更具优势，应该成为门静脉高压食管胃底静脉曲张破裂出血的常规治疗方法之一。经留置药盒行门静脉区域性中西药物灌注治疗肝硬化值得进一步探讨。     

PTVE联合PSE治疗胃底曲张静脉出血的疗效观察

目的探讨经皮胃底曲张静脉栓塞术(PTVE)联合部分脾动脉栓塞术(PSE)治疗胃底曲张静脉出血的疗效。资料与方法27例肝硬化合并食管胃底曲张静脉破裂出血患者(18例急性出血,9例择期手术),21例患者同时实施PTVE+PSE,6例患者PTVE后5～7天再行PSE。对术前、术后门静脉压力变化进行测量;术后1～24个月观察再出血的发生率及胃镜随访胃底曲张静脉消退情况。结果18例急诊手术患者术后出血即刻停止,即时止血率100%。PTVE栓塞后门静脉压升高,同术前比较差异有统计学意义(P<0.05);PTVE+PSE后门静脉压有所降低,但同术前比较差异无统计学意义(P>0.05)。23例术后胃镜随访,显示胃底曲张静脉完全消失9例,部分消失14例,4例门静脉高压性胃病表现。随访期间1～12个月内再出血率为11.11%(3/27),12～24个月因肝功能衰竭死亡2例,再出血率为28.0%(7/25)。6例为曲张静脉出血,其中1例再次行PTVE栓塞曲张静脉后止血,4例为门静脉高压性胃病出血。结论PTVE具有满意的止血效果和消除胃底曲张静脉,联合PSE能抵消PTVE所致的门静脉压升高。PTVE联合PSE既可行急诊止血,亦可作为...     

能谱CT在预测肝硬化门脉高压食管静脉曲张出血风险的应用

＿目的：通过能谱CT探讨肝硬化门脉高压血流动力学改变来预测食管静脉曲张出血风险。方法：41名肝硬化患者行能谱CT扫描,分别记录肝左叶、肝右叶、肝尾状叶、脾脏、门静脉、胃左静脉碘基值,门静脉主干及脾静脉主干内径,比较门脉高压组（门静脉内径≥15 mm或脾静脉内径≥10 mm）与非门脉高压组（门静脉内径＜15 mm或脾静脉内径＜10 mm）、CT下食管静脉曲张组与未曲张组、出血组与未出血组之间能谱参数差异。将出血组与未出血组的能谱参数绘制ROC曲线,选取截点,确定能谱参数对出血风险的诊断价值。结果：胃左静脉指数 GLI （胃左静脉碘基值／门静脉碘基值）与脾静脉主干内径呈正相关（r＝0．358,P＝0．035）。CT下食管静脉曲张组GLI（0．99±0．26）较未曲张组高（0．78±0．22）,P＝0．02。出血组GLI （1．01±0．21）较未出血组高（0．83±0．28）,P＝0．037。GLI临界值为0．87时曲线下面积为0．71,诊断出血风险的敏感性82．4％,特异性65％。结论：胃左静脉指数可以作为预测食管静脉曲张出血风险指标。     

内镜下组织黏合剂栓塞术治疗食管胃底静脉曲张出血的临床研究

目的比较内镜下套扎法及组织黏合剂注射法治疗肝硬化胃底静脉曲张的临床疗效。方法将154例肝硬化食管胃底静脉曲张患者随机分为内镜下套扎组(对照组)及组织黏合剂注射组(观察组),观察两组患者的再次出血发生率、曲张静脉改善有效率及并发症的发生率。结果两组患者手术均成功,均无严重的并发症发生。随访9个月,观察组3、6、9个月内再出血发生率明显低于对照组,而曲张静脉改善的有效率明显高于对照组,差异有统计学意义(P<0.05)。结论内镜下注射组织黏合剂能更加有效的预防再出血的发生,其临床疗效更为确切,可作为治疗食管胃底静脉曲张的首选方法。     

多层螺旋CT门静脉成像对门静脉高压症个体化治疗术前评估的作用

目的：评估多层螺旋CT门静脉成像（multi-slice spiral CT portography,MSCTP）在门静脉高压症个体化治疗术前评估的作用。方法：选择我院2008-01～2011-05门静脉高压症患者行CT门静脉成像并手术治疗患者61例,手术治疗前均依据MSCTP检查并结合肝功、凝血功能等情况,分别进行了内镜下治疗、脾切除或介入脾栓塞术、经皮经肝胃冠状静脉栓塞术、肝内门一腔静脉分流术、外科的断流、分流、联合断分流术。结果：61例全部显示食管和（或）胃底静脉曲张（100%）,伴胃冠状静脉曲张45例（73%）、伴脾肾静脉分流7例（11%）、伴胃肾分流15例（24%）,分别经内镜、介入造影、外科手术中证实。结论：MSCTP可无创性地显示门静脉及其侧支循环的形态、分流方式和程度,对门脉高压症患者的个体化治疗方案的选择具有重要作用。     

B超导向经皮脾穿刺脾静脉行食管胃底静脉栓塞

目的 探讨B超导向经皮经脾穿刺脾静脉行食管胃底静脉栓塞术的安全性及其临床疗效.方法 本组14例,在B超导向下穿刺脾静脉栓塞胃底静脉曲张,随访4周,4周末行胃镜检查,确定有无再次出血.结果 14例均无再次出血及严重并发症发生.结论 B超导向下经皮经脾穿刺脾静脉行食管胃底静脉栓塞创伤小,效果确切,可有效降低上消化道出血.     

Distal arterial splenic embolization via collaterals: report of two cases

Two patients were treated for bleeding gastric varices, developed due to splenic vein occlusion. In one patient with occlusion of the main splenic artery, splenic embolization performed via collaterals facilitated open splenectomy with minimal blood loss. In another patient, bleeding from the gastric varices stopped after partial arterial splenic embolization performed via the accessory left gastric and inferior phrenic arteries. No complications were encountered.     

Verification of thrombus formation just after endoscopic injection sclerotherapy with ligation for esophagogastric varices by venous phase of left gastric arteriography

Management of hepatic venous pressure gradient (HVPG) is important in the treatment of portal hypertension. We report a case that was treated by a hybrid procedure combining endoscopic injection sclerotherapy with ligation (EISL), left gastric artery embolization (LGE), and partial splenic artery embolization (PSE) based on a new concept ``splanchnic caput Medusae.'''' The venous phase of left gastric arteriography just after EISL demonstrated thrombus formation in the gastric varices and the cardiac branch of the left gastric vein. The para-esophageal vein and lesser curvature branch of the left gastric vein were not affected. HVPG decreased from 14 to 11 mmHg immediately after LGE and PSE. 3D-CT reconstruction portal image revealed that the portal system reversed to almost normal form. This is the first case report in which thrombus formation in gastric varices and cardiac branch just after EISL could be demonstrated by the venous phase of left gastric arteriography.     

球囊逆行阻断胃肾分流道联合经皮肝穿胃静脉栓塞治疗伴胃肾分流道的胃静脉曲张

目的 评价球囊逆行阻断胃肾分流道联合经皮肝穿胃静脉栓塞,治疗自发胃肾分流道形成的胃静脉曲张的临床疗效和安全性.方法 8例男性自发胃肾分流道形成的胃静脉曲张患者,年龄40～61岁,平均(50±8)岁,行经股静脉球囊逆行阻断胃肾分流道联合经皮肝穿胃静脉栓塞治疗.结果 8例患者于术成功,术后门静脉压力平均增高5.5 cm H2O(1 cm H2O=0.098 kPa,手术前为35.0～41.0 cm H2O,手术后为39.0～45.5 cm H2O).本组患者术后随访1～46个月,随访期内均未再发消化道出血.结论 球囊逆行阻断胃肾分流道联合经皮肝穿胃静脉栓塞,治疗自发胃肾分流道形成的胃静脉曲张是安全可行的,可作为治疗难以采用内镜下硬化止血治疗的自发胃肾分流道形成的胃静脉曲张的有效方法.     

球囊逆行阻断胃肾分流道联合经皮肝穿胃静脉栓塞治疗伴胃肾分流道的胃静脉曲张

目的 评价球囊逆行阻断胃肾分流道联合经皮肝穿胃静脉栓塞,治疗自发胃肾分流道形成的胃静脉曲张的临床疗效和安全性.方法 8例男性自发胃肾分流道形成的胃静脉曲张患者,年龄40～61岁,平均(50±8)岁,行经股静脉球囊逆行阻断胃肾分流道联合经皮肝穿胃静脉栓塞治疗.结果 8例患者于术成功,术后门静脉压力平均增高5.5 cm H2O(1 cm H2O=0.098 kPa,手术前为35.0～41.0 cm H2O,手术后为39.0～45.5 cm H2O).本组患者术后随访1～46个月,随访期内均未再发消化道出血.结论 球囊逆行阻断胃肾分流道联合经皮肝穿胃静脉栓塞,治疗自发胃肾分流道形成的胃静脉曲张是安全可行的,可作为治疗难以采用内镜下硬化止血治疗的自发胃肾分流道形成的胃静脉曲张的有效方法.     

Percutaneous transhepatic obliteration of gastroesophageal varices: some technical aspects.

Two cases of bleeding from gastroesophageal varices treated by variceal obliteration illustrate multiple routes of variceal supply, and alert embolizing angiographers to the presence of spontaneous portosystemic shunts which should be kept open. In one case, variceal obliteration required embolization of the left gastric vein and a transhepatic collateral originating from the left hepatic portal branch and contributing substantially to variceal filling. A second patient with a relatively large spontaneous splenorenal shunt had recurrent variceal bleeding two months after a successful embolization of the coronary vein and a short gastric vein. A repeat study revealed the recurrent varices were supplied by enlarged right gastric and gastroepiploic veins. Superior mesenteric venography was necessary for their visualization.     

球囊逆行阻断胃肾分流道联合经皮肝穿胃静脉栓塞治疗伴胃肾分流道的胃静脉曲张

目的 评价球囊逆行阻断胃肾分流道联合经皮肝穿胃静脉栓塞,治疗自发胃肾分流道形成的胃静脉曲张的临床疗效和安全性.方法 8例男性自发胃肾分流道形成的胃静脉曲张患者,年龄40～61岁,平均(50±8)岁,行经股静脉球囊逆行阻断胃肾分流道联合经皮肝穿胃静脉栓塞治疗.结果 8例患者于术成功,术后门静脉压力平均增高5.5 cm H2O(1 cm H2O=0.098 kPa,手术前为35.0～41.0 cm H2O,手术后为39.0～45.5 cm H2O).本组患者术后随访1～46个月,随访期内均未再发消化道出血.结论 球囊逆行阻断胃肾分流道联合经皮肝穿胃静脉栓塞,治疗自发胃肾分流道形成的胃静脉曲张是安全可行的,可作为治疗难以采用内镜下硬化止血治疗的自发胃肾分流道形成的胃静脉曲张的有效方法.

Abstract：

Objective To evaluate the efficacy and the safety of retrograde gastrorenal shunt balloon occlusion combined with percutaneous transhepatic gastric varices embolization to treat the gastric varices with spontaneous gastrorenal shunt. Methods From Nov. 2006 to Jun. 2010, retrograde gastrorenal shunt balloon occlusion combined with percutaneous transhepatic gastric varices embolization was performed on 8 patients who had gastric varices with spontaneous gastrorenal shunt. All the patients were men and the age ranged from 40 to 61 years. The balloon catheter was inserted into the spontaneous gastrorenal shunt through the right femoral vein, then percutaneous transhepatic splenic vein venograghy was performed to identify the number and morphology of gastric varices. After that gastric varices embolization was performed while the balloon catheter was dilated, which was withdrawn one day after the procedure. Results Technical success of interventional treatment was achieved in all 8 cases with no significant complications. The increase of average portal venous pressure was 5.5 cm H2O (1 cm H2O = 0. 098 kPa,preoperative 35.0 to 41.0 cm H2O,postoperative 39.0 to 45.5 cm H2O). After follow up of 1 to 46 months, no recurrence haemorrhage occurred. Conclusion Retrograde gastrorenal shunt balloon occlusion combined with percutaneous transhepatie gastric variees embolization can be safely performed and could be one of the effective choices for patients who had gastric varices with spontaneous gastrorenal shunt, which is not suitable to treat by the endoscopic sclerotherapy.     

口服有回声型对比剂经腹彩超在诊断胃底静脉曲张中的价值

目的:评价口服有回声型对比剂经腹彩超在诊断胃底静脉曲张中的价值。方法:对85例肝硬化伴有门静脉高压患者采用口服有回声型对比剂充盈胃腔后经腹彩超检查,与胃镜检查结果进行比较。结果:超声检出胃底静脉曲张33例,经胃镜证实胃底静脉曲张49例,超声假阴性16例,均为轻度胃底静脉曲张。超声诊断正确率为81.2%(69/85);敏感性为67.3%(33/49);特异性为100%(36/36)。结论:口服有回声型对比剂经腹彩超对胃底静脉曲张的显像具有较高的临床应用价值。