内镜套扎联合部分脾栓塞术治疗门脉高压症及其对血流动力学的影响

目的 :探讨一种新的治疗门脉高压症的手术方法。方法 :对 41例合并食管静脉曲张和脾功能亢进的门脉高压症患者实施内镜套扎 -部分脾栓塞联合治疗 ,手术前后采用彩色多普勒超声检查门奇静脉侧支循环情况 ,与对照组进行对比研究。结果 :除 1例患者出现异位栓塞死亡 ,1例出现脾脓肿经开腹手术治疗得到治愈外 ,未发生其他严重并发症。联合术后患者食管曲张静脉得到根治 ,脾功能亢进缓解。手术后患者门静脉血流速度减慢 ,血流量减少 (P <0 .0 5) ,奇静脉血流量降低 (P <0 .0 1 ) ,胃左静脉血流速度减慢 (P <0 .0 5)。术后随访 2～ 2 4个月 ,未出现复发性出血。结论 :联合术能有效地治疗门脉高压症食管静脉曲张出血和脾功能亢进 ,减少了闭塞曲张静脉所需重复套扎次数及近期再出血 ,同时术后减少了门静脉血流速度 ,血流量 ,降低了套扎术后复发出血的风险 ,该方法操作简单 ,侵袭性小 ,尤其适应于肝功能较差 ,难以耐受分流及断流手术的门脉高压症患者。

INFLUENCES OF ENDOSCOPIC VARICEAL LIGATION COMBINED WITH PARTIAL SPLENIC EMBOLIZATION ON PORTAL HEMODYNAMICS IN PATIENTS WITH PORTAL HYPERTENSION

Objective:To evaluate the feasibility of the new method EVL-PSE for patients with portal hypertension.Methods:From May 1999 to May 2002,Forty-one cases with portal hypertension underwent endoscopic variceal ligation and partial splenic embolization. Hemodynamics of the portal trunk(PT), the left gastric vein and azygos vein, including maximum velocity, flow volume, vein diameter, were assessed by using color Dopple ultrasound.Results:One case died from pulmonary artery embolism. One case of splenic abscess was successfully managed by laparotomy. The esophageal varices and hypersplenism had been well managed after operation in other patients. Postoperatively the portal trunk flow volume and velocity significantly reduced ( P <0.05), the flow volume of the left gastric vein and azygos vein reduced either after operation. During the follow up period , no recurrent bleeding was found. Conclusions:EVL-PSE has less traumas, less complications and high eradication of esophageal varices, the portal trunk volume decreased after operation. The operation can be used safely in the clinic treatment for patients with portal hypertension.