介入血管栓塞联合内镜注射硬化治疗食道胃底静脉曲张.doc

介入血管栓塞联合内镜注射硬化治疗食道胃底静脉曲张 Combined Interventional Vascular Embolization With Endoscopic Injection For Esophagogastric Varices 武汉市第三医院 放射科 程正友 杨四清 刘义 龙焱华 汪浩 许觅 李凤桂 430060 摘 要 目的 探讨介入栓塞联合内镜注射治疗食道胃底静脉曲张的临床效果。材料和方法25例食道胃底静脉曲张患者，分别行经皮肝穿冠状静脉栓塞（PTVE）和球囊阻断静脉逆行硬化闭塞胃静脉曲张（BRTO），并发脾功能亢进者，同时行部分脾动脉栓塞（PSE）。术后对有残留食道静脉曲张的病例行硬化剂注射治疗（EIS）。全部治疗完成后常规临床观察，并定期复查胃镜和CT增强扫描。结果25例患者，PTVE组7例，行PTVE+PSE；BRTO组18例，11例行BRTO，6例行BRTO+PSE，1例BRTO手术失败；术后11例患者接受内镜注射治疗一次，4例患者接受二次注射治疗。3例患者死亡，其中1例于术后2月死于再发出血。结论 血管介入联合内镜注射硬化治疗，具有可靠的预防上消化道出血的效果。 关键词：球囊阻断逆行静脉闭塞；食道静脉曲张；胃肾分流；泡沫硬化剂 CHENG zheng-you, YANG Si-qing, LIU Yi, LONG Yan-hua, WANG Hao, XU Mi, LI feng-gui. Department of Radiology, Wuhan Third Hospital. Wuhan. Hubei Province 430060. China 【Abstract】 Purpose: To evaluate the clinical efficacy of interventional vascular embolization combined with endoscopic injection sclerotherapy for esophagogastric varices. Methods：PTVE or B-RTO was performed in 25 patients with esophagogastric varices. Partial spenic artery emoblization was performed simultaneously in patients with hypersplenia. Endoscopic injection sclerotherapy was followed in patients remaining esophageal varices. For evaluating efficacy, we observed clinical manifestations and followed up the change of esophagogastric varices by endoscopy and enhanced CT scan. Results：PTVE+PSE was performed in 7 cases, B-RTO was in 11 cases, and BRTO+PSE was in 6 cases. One B-RTO procedure failed. Endoscopic injection sclerotherapy was performed one time for 11patients that remained esophagogastric varices after procedure. Towice for 4 patients. 3 patients died, one of them died from rebleeding at 2 months after procedure. Conclusions：Interventional vascular embolization combined with endoscopic injection sclerotherapy for esophagogastric varices has reliable efficacy to prevent recurrent bleeding. 【Key Words】 B-RTO-balloon-occluded retrograde transvenous obliteration; Esophagogastric varices; Gastrorenal shunt; Sclerosing agent foam. 针对肝硬化门脉高压、食道胃底静脉曲张破裂所致的消化道出血