摘要
目的:采用EV-PSE(内镜下曲张静脉套扎-部分脾栓塞术)联合治疗肝硬化食管静脉曲张出血、脾功能亢进、门脉高压性胃病和胃静脉曲张,并随访6～74个月,平均42.2个月,旨在研究其对门脉高压并发症近期、远期疗效、安全性及有无免疫功能损害。方法:急诊胃镜确诊食管静脉曲张出血47例,立即行急诊EVL止血。首次止血成功后行PSE,必要时再行重复EVL。结果:47例食管静脉曲张出血均止血成功,无近期再发出血,32例曲张静脉消失,15例退缩到1度,曲张静脉消失率68.1%,(P<0.05)。PSE后,47例外周血白细胞、血小板均显著上升(P<0.01),47例免疫功能无明显改变(P>0.05)。28例门脉高压性胃病程度均减轻。9例并胃静脉曲张者,胃静脉曲张程度减轻。CT测量脾梗面积30%～70%。术后无严重并发症,无肝肾功能损害加重。随访6～74个月,平均42.2个月,仅2例复发静脉曲张达Ⅲ度,复发率4.3%,其中1例复发出血,复发出血率2.1%。结论:EVL-PSE联合治疗肝硬化食管静脉曲张出血、脾功能亢进、门脉高压性胃病和胃静脉曲张疗效确切、安全,对免疫功能无影响。联合治疗减少近期、远期复发出血,降低曲张静脉复发率及重复套扎次数。
Objective：To treat esophageal varix bleeding in liver cirrhosis,hypersplenism,portal hypertensive hypertensive gastropathy and gastric varix by using EVL-PSE（Endoscopie Variceal Ligation-Partial Splenic Embolization）combined therapy,with follow-up for 6-74 months and average 42.2months.The aim is to investigate the short- and long-term effect on portal hypertension complications,safety and impairments on immune function. Methods：There were 47 cases of esophageal varix bleeding being diagnosed by emergency gastrnscopy and were given EVL hemostasis immediately.PSE was performed after the first successful hemostasis and repeated EVL was done if necessary. Results：Hemostasis in 47 cases of esophageal varix bleeding was successful without short-term re-bleeding,among which 32 cases of varices disappeared, 15 cases were retraced to degree I,the rate of varix disappearance was 68.1%（P〈0.05）.The level of peripheral leukocytes and platelet of the 47cases was significantly increased after PSE（P〈0.01）.Immune function had no obviouse change in 47 cases（P〉0.05）.The degree of portal hypertensive gastropathy in 28 cases reduced.The degree of varices in 9 cases complicated with gastric vareces relieved.The splenic infarction size was 30%-70% through CT measurement.There were no severe complications,no aggravation of liver and renal function impairment after operation.Followed-up for 6-74 months with the average of 42,2 months,only 2 cases of varicose veins relapsed to degree Ⅲ,the recurrence rate was 4.3%.One cases was re-bleeding,the recurrent rate of bleeding was 2.1%.ConetusIons：EVL-PSE combined treatment on esophageal varix bleeding,hypersplenism,portal hypertensive gastropathy and gastric varix is definitely effective and safe and has no effect on immune function.The combination treatment of EVL and PSE can reduce recent and long-term re-bleeding,decrease the recurrence rate of varices veins and the times of repeating ligation.
出处
《中国医药导刊》
2009年第11期1819-1821,共3页
Chinese Journal of Medicinal Guide
关键词
门脉高压并发症
镜下套扎
脾检塞
Complications of portal hypertensions
Endoscopic tigation
Splenic embolization
