内镜曲张静脉套扎-部分脾栓塞联合术治疗门静脉高压症

对１３例门脉高压症合并食管静脉曲张出血和脾功能亢进的患者实施内镜曲张静脉套扎－部分脾栓塞术联合治疗。效果如下：１３例患者曲张静脉均完全闭塞；其中９例活动性出血均止血成功（除１例早期再出血外，随访２～１６月，未见复发出血）；脾栓塞后外周血白细胞和血小板均显著上升（Ｐ＜０．０５），血红蛋白浓度无明显改变。未发现严重并发症和死亡病例。提示本联合术能安全有效地治疗门脉高压症出血和脾功能亢进，并能减少闭塞曲张静脉所需重复内镜套扎的次数及近期再出血。

Endoscopic variceal ligation combined with partial splenic embolization: preliminary clinical results

Endoscopic variceal ligation combined with partial splenic embolization (EVL PSE) was performed in a group of 13 patients with esophageal variceal bleeding and hypersplenism due to portal hypertension from January 1997 to March 1998. PSE was performed one to two weeks before or one week after initial EVL, and a range of 30% to 60% of the splenic parenchyma was embolized. Repeated EVL was performed at two week intervals until the varices were eradicated. Active bleeding in the nine patients was successfully controlled and all the varices of the 13 patients were eradicated after EVL PSE. Eradication of the varices required two to five(mean 3.1) EVL sessions, follow up ranging from 2 to 16 months(mean 6.9 months). In all but one case, no rebleeding occurred. All patients after PSE showed a good response on peripheral blood cell count and reduction of splenomegaly. No major complication or death related to the combination therapy was observed. Preliminary results in this study show that this combination therapy may result in more rapid eradication of the varices and reduce rebleeding after endoscopic variceal ligation. However, more data and studies may be necessary for further evaluation.