介入断流术治疗肝硬化门脉高压合并上消化道出血的疗效分析(附11例报告)

目的通过对肝硬化门静脉高压并发上消化道大出血的患者采用经皮肝穿刺食管胃底静脉栓塞术联合部分脾栓塞治疗,评价其对肝硬化门静脉高压并发上消化道大出血的疗效。方法回顾性分析11例肝硬化门静脉高压并发上消化道大出血采用介入断流术治疗的病例资料,测定治疗前后门静脉的压力、门静脉的内径及血小板的变化情况,并进行随访观察以判定疗效。结果本组患者介入操作成功率和即时止血率均为100%;胃冠状静脉栓塞前、胃冠状静脉栓塞后和脾动脉栓塞后的门静脉压力分别为:(37.24±4.02)、(40.38±4.15)和(26.33±4.14)cmH_2O,胃冠状静脉栓塞前后门静脉压力比较,(P=0.088);脾动脉栓塞后与胃冠状静脉栓塞前门静脉压力比较,(P0.001);介入断流术治疗前和治疗后两周B超测量的门静脉内径为:(1.39±0.16)cm、(1.39±0.15)cm,治疗前后门静脉内径比较,(P=0.97);介入断流术治疗前和治疗后两周的血小板数为:(59.36±16.91)×10~9/L、(173.64±55.47)×10~9/L,治疗前后血小板数比较,(P0.001)。结论介入断流术止血效果迅速可靠,即时降低了门静脉压力,并逐步改善外周血情况,是治疗肝硬化门静脉高压合并上消化道出血的一种安全有效手段。

Analysis of the curative effect of interventional devascularization in hepatic cirrhosis,portal hypertension combined with upper gastrointestinal hemorrhage

Objective To evaluate the curative effect of interventional embolization of gastroesophageal and splenic veins in patients with upper gastrointestinal hemorrhage from liver cirrhosis and portal hypertension. Methods 11 patients with portal hypertension accompanying gastroesophageal variceal hemorrhage were treated with interventional devascularization. The portal vein pressure, portal vein diameter and platelet before and after treatment as well as the therapeutic effect were evaluated. Results The technical success rate and the rate of hemostasis were 100%. The portal vein pressure was （37.24±4.02）, （40.38±4.15） and （26.33±4.14）cm H2O, respectively before and after the gastroesophageal variceal embolization （P= 0.088） and after partial splenic vein embolization （P〈 0.001）. The portal vein diameter was （1.39±0.16）cm,（1.39±0.15）cm, respectively （P = 0.97） before and 2 weeks after interventional devascularization. The platelet count was （59.36±16.91）×10^9/L,（173.64±55.47）×10^9/L （P 〈 0.001）, respectively before and 2 weeks after interventional devascularization. Conclusion Interventional devascularization can control bleeding immediately, decrease the portal vein pressure, and improve the peri-vascular platetets. It is safe and efficient in treating patients with upper gastrointestinal hemorrhage from liver cirrhosis and portal hypertension.