联合导向下经皮经肝胃冠状静脉栓塞治疗食管胃底静脉曲张出血

目的 评价经皮经肝胃冠状静脉栓塞术在治疗肝硬化患者食管、胃底静脉曲张破裂出血中的应用价值。方法 对l8例肝硬化合并食管、胃底静脉曲张破裂出血患者，其中8例患者大出血中急诊栓塞，l0例患者出血后择期栓塞。在B超和X线联合导向下，经皮经肝穿刺门静脉。所有患者在B超引导下门静脉穿刺一次成功，行门静脉造影和胃冠状静脉造影及栓塞。结果 l7例患者胃冠状静脉栓塞成功，其中l例栓塞后6h再次出血，行经颈静脉肝内门体分流手术，血止。急诊止血率87．5％，栓塞成功率94．4％。l～24个月随访期内，再出血4例，肝功衰竭2例，肝癌2例，共死亡6例，l2例存活。结论 对于肝硬化食管、胃底静脉曲张破裂出血患者，经B超和X线联合导向下，经皮经肝胃冠状静脉栓塞术是一种安全、有效的止血方法。

Percutaneous transhepatic coronary vein occlusion to treat esophagogastric variceal hemorrhage

Objective To observe the effects and safety of percutaneous transhepatic coronary vein occlusion under ultrasound type B and X-ray guiding to treat esophagogastric variceal hemorrhage in cirrhotic patients. Methods Eighteen cirrhotic patients suffering from esophagogastric variceal hemorrhage were treated with percutaneous transhepatic coronary vein occlusion under ultrasound type B and X-ray guiding. Among them, 8 patients were treated during emergency bleeding and another 10 patients after hemorrhage. Results Seventeen patients were successfully treated with coronary vein occlusion. One patient rebled after 6 hours of the treatment and was treated successfully with transjugular intrahepatic portosystemic shunt. The emergency hemostastic treatment efficacy was 87.5%, and successful occlusion occurred in 94.4%. All patients were followed up for 1-24 months. There were 4 patients who suffered from rebleeding, 2 patients from hepatic failure and 2 patients from hepatocellular carcinoma. There were 12 patients survived during the follow-up. Conclusion Percutaneous transhepatic coronary vein occlusion under the type B ultrasounography and X-ray guiding is safe and efficient to treat esophagogastric variceal hemorrhage in cirrhotic patients.