经皮经肝α-氰基丙烯酸正丁酯胶和生物蛋白胶联合栓塞治疗食管胃底静脉曲张20例

目的介绍经皮经肝α-氰基丙烯酸正丁酯(NBCA胶,n-butyl-2-cyanoacrylate)和生物蛋白胶联合栓塞食管胃底静脉曲张的应用。方法采用经皮经肝NBCA胶和生物蛋白胶联合栓塞胃冠状静脉和胃短静脉为主的方法治疗门静脉高压食管胃底静脉曲张患者20例,生物蛋白胶以栓塞胃部曲张静脉的流出端为主,NBCA胶栓塞胃部曲张静脉的主体和输入段,部分加用弹簧圈栓塞减慢血流。15例患者同时行部分性脾动脉栓塞。结果栓塞成功16例(80%),术后即刻食管胃底曲张静脉血流消失而且出血控制。随访1~11个月(平均4.3个月),成功栓塞的16例患者无1例发生再出血,其中胃镜复查11例,5例曲张静脉基本消失,4例明显减轻,2例稍有减轻。4例患者曲张静脉内NBCA充填不充分,致使栓塞不彻底,其中2例发生再出血。无1患者发生异位栓塞和胃黏膜的过度栓塞。结论经皮经肝NBCA胶和生物蛋白胶联合栓塞食管胃底静脉曲张可有效防止异位栓塞及过度栓塞,安全而且疗效确切,可作为治疗食管胃底静脉曲张破裂急性出血的重要治疗手段之一。能否彻底栓塞是决定疗效的主要因素。

Percutaneous transhepatic embolization of gastroesophageal varices by fibrin sealant and N-butyl-2-cyanoacrylate

Objective To study the clinical efficacy of percutaneous transhepatic embolization of gastroesophageal varices by fibrin sealant and n-butyl-2-cyanoacrylate(NBCA).Methods 20 patients with gastroesophageal varices were treated with percutaneous trasnshepatic embolization with fibrin sealant and NBCA.Fibrin Sealant was injected into the drainage vein with flow-control,NBCA was injected into the main of varices and the afferent vein,and coils were placed at the stem of the afferent veins included the ostium of those.15 patients also underwent partial splenic embolization.Results The embolization were performed successfully in 16 patients(80%).Venogram showed absence.of gastroesophageal varices immediately and bleeding controlled satisfactorily in all the 16 patients after the treatment.11 of the 16 patients were followed-up with a mean period of 4.3 months(1-11months),no one occurred rebleeding;varices disappeared in 5 cases,reduced obviously in 4 cases and reduced mildly in 2 cases.4 patients cannot be embolized thoroughly due to injecting NBCA unsufficiently,2 patients occurred rebleeding.Neither other-organ-embolization nor over-embolization or infarction of the gastric mucosa happened.Conclusion Percutaneous transhepatic embolization of the gastroesophageal varices with both fibrin sealant and NBCA simultaneously is an effective and safe method for the treatment of gastroesophageal varices,and it can prevent the other-organ-embolization and over-embolization or putrescence of the gastric mucosa effectively.It should be taken as one of the important treatment to the acute varices hemorrhage.Whether embolization thoroughly is the key factor to the treative efficacy.