胃冠状静脉栓塞联合脾栓塞治疗肝硬化消化道出血

目的 探讨经皮经肝胃冠状静脉栓塞(PTVE)联合选择性脾红髓小动脉栓塞(PSAE)治疗肝硬化消化道出血的疗效. 方法 26例肝硬化、门静脉高压并胃底静脉重度曲张出血的患者,经皮经肝穿刺门静脉,造影后找到胃冠状静脉、胃短静脉,并栓塞该静脉；再择期行选择性脾红髓栓塞,以降低门静脉压力、缓解脾功能亢进.并术后随访15月,同时胃镜复查. 结果 术后26例患者当时急性出血均被控制,术后造影示胃冠状静脉、胃短静脉闭塞,随访期间,22例(84.62％)患者上消化道出血症状消失,19例(73.08％)胃底静脉曲张完全消失,3例(11.54％)胃底静脉曲张复发,4例(15.38％)再发食道胃底破裂出血.但所有患者脾功能亢进症状均明显改善.结论 经皮经肝胃冠状静脉栓塞联合选择性脾红髓小动脉栓塞治疗肝硬化消化道出血,不但可以控制消化道出血,还可以降低门静脉压力,缓解脾功能亢进,且复发率低,长期疗效确切.值得推广.

Gastric Coronary Vein Embolization Combined Splenic Embolization for Gastrointestinal Bleeding in Cirrhosis of the Study

ObjectiveTo study the feasibility and efficacy of percutaneous transhepatic embolization of gastroesophageal varices combined with partial splenic embolization in the treatment of liver cirrhosis and hemorrhage.Methods26 cases of liver cirrhosis,portal hypertension and gastric variceal severe varicose bleeding in patients underwent percutaneous transhepatic portal vein angiography to identify the gastric coronary vein and short gastric vein,which were then embolized (with PVA or steel ring.et).Patients then underwent elective,selective splenic red pulp thrombosis to reduce portal pressure and relieve hypersplenism.Postoperative follow-up occurred at 15 months by endoscopy.ResultsOf the 26 patients treated for acute postoperative bleeding,22 (84.62%) maintained gastric coronary vein and short gastric vein occlusion at the 15 month postoperative follow-up.Of these,19 cases (73.08%) had persistent symptoms of upper gastrointestinal bleeding,while gastric varicose veins disappeared in 3 cases (11.54%).4 patients (15.38%) did not maintain occlusion of the gastric coronary vein and short gastric vein had recurrent esophageal and gastric bleeding.However,all 26 patients demonstrated significant improvements in symptoms related to hypersplenism.ConclusionPercutaneous transhepatic coronary vein embolization combined with selective splenic red pulp artery embolization demonstrates efficacy in the treatment of liver cirrhosis associated with gastrointestinal bleeding.Control of gastrointestinal bleeding can be achieved with reduced portal pressure,relief of hypersplenism,and may lead to a long-term curative effect in some patients.Therefore,Percutaneous transhepatic coronary vein embolization combined with selective splenic red pulp artery embolization presents as an attractive modality to be considered for the treatment of hemorrhage secondary to liver cirrhosis.