经皮肝穿胃左静脉栓塞联合部分脾栓塞术治疗门脉性上消化道出血

目的探讨经皮肝穿胃左静脉栓塞联合部分脾栓塞术治疗门脉性上消化道出血的临床效果。方法分析25例门脉高压引起的上消化道大出血患者资料，经皮肝穿刺门静脉，造影确认胃左静脉后经导管注入无水酒精栓塞食管胃底曲张静脉，再用钢圈栓塞胃左静脉主干。采用Seldinger’s技术穿刺右侧股动脉行部分脾栓塞术。术后1个月随访观察患者临床症状改善情况、外周血象、门脉压力变化和有无并发症等。结果25例患者全部栓塞成功，即时止血率达100％，上消化道出血症状消失，临床症状减轻，外周血象改善，白细胞及血小板数量增加，门脉压力减低，术中、术后均未出现严重并发症。结论经皮肝穿胃左静脉栓塞联合部分脾栓塞术治疗门脉性上消化道出血创伤较小，即时止血效果好，是一种安全有效的治疗方法。

Therapeutic Effects of Percutaneous Transhepatic Left Gastric Vien Embolization Combined with Partial Splenic Embolization for Massive Hemorrhage of Upper Digestive Tract by Portal Hypertension

Objective To evaluate the efficiency of percurtenous transhepatic left gastric vien embolization combined with partial splenic embolization for massive hemorrhage of upper digestive tract by portal hypertension. Methods Clinical data were analyzed that 25 cases manifested massive haemorrhage of upper digestive tract by portal hypertention. Percutaneous liver puncture, portal was punctured and catheter was inserted into left gastric vein. Absolute ethanol was injected into left gastric vein, the coil were used to embolize left main gastric vein. Partial splenic embolization were used by Seldinger＇ s technique through right femoral artery. Results Clinical symptom, white blood cell, blood platelet count, portal vein pressure, complication were observed. Results Total 25 cases embolization was success. The left gastric vein closed, and hemorrhage stoped, clinical symptom was improved~ white blood cell and blood platelet count were increased, the portal vein pressure were decreased, there was no severe complication in all patients. Conclusion It is effective, safe, less trauma therapy for percutaneous transhepatic left gastric vein embolization combined with partial splenic embolization for massive hemorrhage of upper digestive tract by portal hypertension.