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门脉高压症的双介入栓塞术与外科断流加脾切除疗效对比研究

冯凯,张春清,刘福利,许洪伟,王京   

  1. 山东省立医院消化科, 山东 济南 250021
  • 收稿日期:2006-11-26 修回日期:1900-01-01 出版日期:2007-07-24 发布日期:2007-07-24
  • 通讯作者: 冯凯

Double embolization and pericardial devascularization with splenectomy in the treatment of portal hypertension: a comparative study

FENG Kai, ZHANG Chun-qing, LIU Fu-li, XU Hong-wei, WANG Jing   

  1. Department of Digestive Disease, Shandong Provincial Hospital, Jinan 250021, Shandong, China
  • Received:2006-11-26 Revised:1900-01-01 Online:2007-07-24 Published:2007-07-24
  • Contact: FENG Kai

摘要: 目的:通过对照研究的方法,探讨应用TH胶行经皮经肝食管胃底曲张静脉栓塞术(PTVE)联合部分脾栓塞术(PSE)的双介入栓塞术在门脉高压食管胃底曲张静脉曲张破裂出血及脾功能亢进中的应用价值。方法:147例门静脉高压症并食管胃底静脉曲张的患者,其中75例行PTVE+PSE术(介入组),72例行贲门周围血管离断联合脾切除术(手术组),对比两组患者手术前后肝功能、白细胞、血小板改变、止血率,并发症及随访5年期间死亡率、再出血率及曲张静脉再发生率变化。结果:两组患者术后止血率均为100%,肝功能改善,白细胞及血小板较术前明显升高(P<0.05),但手术组严重并发症的发生高于介入组;术后5年两组间死亡率、再出血率无统计学差异(P>0.05),但曲张静脉再发生率手术组显著高于介入组(P<0.05)。结论:以TH胶为栓塞剂行PTVE+PSE治疗门静脉高压症食管胃底静脉曲张和脾亢安全、有效、并发症少,值得临床应用与推广。

Abstract: Objective: To explore the effect of percutaneous embolization of gastroesophageal varices, with TH glue as the embolus, combined with partial splenic embolization(PTVE+PSE) and pericardical devascularization plus splenectomy in the treatment of portal hypertension. Methods: A total of 147 cases were divided into two groups: 75 cases in the intervention group (PTVE+PSE) and 72 cases in the operation group. The incidence of re-bleeding, death, gastroesophageal revarices, the improvement of splenemagly and the complications were observed in the two groups. Results: All procedures and operations were successful. At the beginning of the five-year follow-up, there were no differences in the mortality and re-bleeding, and the improvement of splenemagly was remarkable in both groups. With time, the rate of re-bleeding and gastroesophageal variceal in the operation group was higher than that of the intervention group. Also, the complications in the operation group were more serious than that in the intervention group during perioperation, which increased the cost and time in hospital. Conclusion: With TH glues as the embolus, PTVE combined with PSE is safe, reasonable and effective for gastroesophageal varices. This treatment is able to replace pericardial devascularization plus splenectomy.

Key words: Portal hypertention, Gastroesophageal varices, TH glue, percutaeous transhepatic variceal embolization, Partial splenic embolization devascularization, Splenectomy

中图分类号: 

  • R657.34
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