内镜下静脉曲张套扎术联合部分脾栓塞术治疗门静脉高压症的疗效
Therapeutic effects of endoscopic variceal ligation combined with partial splenic embolization for portal hypertension.
作者信息
Xu Rui-Yun, Liu Bo, Lin Nan
机构信息
Department of General Surgery, The Third Affiliated Hospital, Sun-Yet-San University, Guangzhou 510630, Guangdong Province, China.
出版信息
World J Gastroenterol. 2004 Apr 1;10(7):1072-4. doi: 10.3748/wjg.v10.i7.1072.
Abstract
AIM
To evaluate the feasibility of a new strategy of endoscopic variceal ligation combined with partial splenic embolization (EVL-PSE) for patients with cirrhosis and portal hypertension.
METHODS
From May 1999 to May 2002, 41 cases with cirrhosis and portal hypertension underwent EVL-PSE. Hemodynamics of the main portal vein (MPV), the left gastric vein (LGV) and azygos vein, including maximum velocity, flow rate and vein diameter, were assessed by Doppler ultrasonography.
RESULTS
One case died from pulmonary artery embolism. One case complicated with splenic abscess was successfully managed by laparotomy. The esophageal varices and hypersplenism were well controlled after EVL-PSE in other patients. After EVL-PSE, the flow rate and velocity of MPV was significantly reduced (P<0.05), as well as the flow rate of the LGV and azygos vein. During the follow-up, no recurrent bleeding was found.
CONCLUSION
Being more convenient and less invasive, EVL-PSE is hopeful to be a proper intervention strategy for portal hypertensive patients with impaired hepatic function or those intolerant to shunting or devascularization surgery.
摘要
目的
评估内镜下静脉曲张结扎术联合部分脾栓塞术（EVL-PSE）治疗肝硬化门静脉高压症患者的可行性。
方法
1999年5月至2002年5月，41例肝硬化门静脉高压症患者接受了EVL-PSE治疗。采用多普勒超声评估门静脉主干（MPV）、胃左静脉（LGV）和奇静脉的血流动力学，包括最大流速、流量和静脉直径。
结果
1例死于肺动脉栓塞。1例并发脾脓肿，经剖腹手术成功治疗。其他患者经EVL-PSE治疗后，食管静脉曲张和脾功能亢进得到良好控制。EVL-PSE术后，MPV的流量和流速显著降低（P<0.05），LGV和奇静脉的流量也显著降低。随访期间，未发现复发出血。
结论
EVL-PSE操作更简便、创伤更小，有望成为肝功能受损或不耐受分流或断流手术的门静脉高压症患者的合适干预策略。
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