经食管内窥镜曲张静脉结扎联合部分脾栓塞术治疗门静脉高压症

目的 研究内镜下食管曲张静脉结扎联合部分脾栓塞术治疗门静脉高压症的临床疗效。方法自1999年5月至2003年2月对68例合并食管静脉曲张和脾功能亢进的门静脉高压症患者实施内镜结扎加部分脾栓塞术进行治疗,观察术后食管曲张静脉闭塞和止血效果及并发症和死亡率,门奇静脉侧支循环情况,并与对照组进行对比。结果联合术后患者食管曲张静脉获得根治,脾功能亢进缓解,门静脉血流速度减慢,血流量减少(P＜0．05),奇静脉血流量降低(P＜0．01),胃左静脉血流速度减慢(P＜0．05)。术后随访2-24个月,未出现复发性出血。结论内镜结扎联合部分脾栓塞术能有效地治疗门静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结扎次数及近期再出血,对于肝功能较差、难以耐受分流及断流手术的患者尤为适用。

Treatment of portal hypertension by endoscopic esophageal ligation of varicose veins combined with partial splenic embolization

Objective To evaluate the feasibility and efficacy of a new method of endoscopic esophageal variceal ligation combined with partial splenic embolization (EVL PSE) for the patients with portal hypertension. Methods From May 1999 to February 2003, sixty eight patients with portal hypertension underwent EVL PSE, and hemodynamics of the portal trunk (PT), the left gastric vein and azygos vein, including maximum velocity, flow volume, vein diameter, were assessed using color ultrasound Doppler. Results The esophageal varices and hypersplenism were greatly ameliorated after operation in patients who had undergone EVL PSE. Postoperaive portal trunk flow volume and velocity were significantly reduced (P<0 05), and flow volume of the left gastric vein as well as the azygos vein were also reduced after operation. During 2 24 month follow up, no recurrent bleeding was found. Conclusions EVL PSE is less traumatic with less complications, and results in marked eradication of esophageal varices, it can be carried out safely in the clinical treatment for patients with portal hypertension.