不同介入途径胃冠状静脉栓塞术治疗肝硬化门静脉高压出血的效果比较

发布时间：2018-03-04 18:38

本文选题：门静脉高压　切入点：胃冠状静脉栓塞术　出处：《广东医学》2015年03期 　论文类型：期刊论文

【摘要】：目的探讨几种介入方式进行胃冠状静脉栓塞术治疗肝硬化门静脉高压出血的效果及价值。方法72例成功完成胃冠状静脉栓塞术患者,其中12例行单纯经皮经肝穿刺胃冠状静脉栓塞术(PTVE),32例行PTVE联合部分脾动脉栓塞术(PSE),28例行经颈静脉肝内门体分流术(TIPS)联合经颈静脉冠状静脉栓塞术(TCVE)。比较3种手术方式止血效果,手术前后食管胃底静脉曲张程度,脾、门静脉系统压力、血流量、血管内径,住院花费及随访情况。结果 3种方式均止血成功,成功率均为100%。单纯PTVE费用低,但复发出血率明显高于PTVE联合PSE,以及TIPS联合TCVE。TIPS联合TCVE降门静脉压作用显著,但住院费用比PTVE联合PSE更高。结论胃冠状静脉栓塞术联合PSE或TIPS治疗肝硬化门静脉高压出血均能取得明显效果。如经济状况允许,采用TIPS联合TCVE远期疗效更好。而在经济欠发达地区,PTVE联合PSE是一种不错的选择。
[Abstract]:Objective to evaluate the efficacy and value of several interventional methods in the treatment of portal hypertension hemorrhage in cirrhotic patients. Methods 72 patients with gastric coronary vein embolization were treated successfully. Among them, 12 cases were treated by percutaneous transhepatic gastric coronary vein embolization (PTVEV). 32 cases were treated with PTVE combined with partial splenic artery embolization. 28 cases were treated with transjugular intrahepatic portosystemic shunt (PTVE) combined with transjugular coronary vein embolization. Before and after operation, the degree of esophageal and gastric varices, the pressure of spleen, portal vein system, blood flow, the diameter of blood vessel, the cost of hospitalization and follow-up were all successful, the success rate was 1000.The cost of simple PTVE was low. However, the rate of recurrent bleeding was significantly higher than that of PTVE combined with PSE, and that of TIPS combined with TCVE.TIPS combined with TCVE was significantly lower than that of TCVE. But the cost of hospitalization was higher than that of PTVE combined with PSE. Conclusion gastric coronary vein embolization combined with PSE or TIPS can achieve significant results in the treatment of portal hypertension hemorrhage due to cirrhosis. The long-term effect of TIPS combined with TCVE is better than that of TCVE, but it is a good choice in less developed areas.
【作者单位】：南昌大学第二附属医院消化内科;华东交通大学理学院;
【分类号】：R575.2

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