Tajiri T, Onda M, Umehara M, Yoshida H, Yamashita K, Kim D Y, Mamada Y
First Department of Surgery, Nippon Medical School, Tokyo, Japan.
Nihon Geka Gakkai Zasshi. 1989 Sep;90(9):1541-4.
To increase durability for long term control of bleeding, additional treatment has to be performed. Since Oct. 1979, various embolizations that is percutaneous transhepatic obliteration (PTO), splenic artery embolization (SAE) and left gastric artery embolization (LGE) were introduced as conservative treatments, and have been used singly or concomitantly. Embolization has been employed in order to avoid the high risk of emergency operation. Complete hemostasis and prolonged efficacy could be obtained by introducing various embolizations. No emergency operation has been performed since all of these embolizations were introduced in Jan. 1983. The rates of hemostasis (100%), one month survival (90%), 1 year incidence of rebleeding (6.7%), 1 year survival (75.5%) and 3 year survival (62.5%) of emergency cases which received combined embolizations were better than the results of the cases which received emergency operation or endoscopic sclerotherapy alone. Moreover, the patients with gastric varices, including bleeding gastric varices treated with various combined embolizations, showed results of diminished varices in 78.9% of the patients. Thus to increase durability for long term control of bleeding, embolization should be combined according to the patient's hemodynamics, which may result in its extended application.
为提高长期控制出血的耐久性，必须进行额外治疗。自1979年10月以来，各种栓塞术，即经皮经肝闭塞术（PTO）、脾动脉栓塞术（SAE）和胃左动脉栓塞术（LGE）作为保守治疗方法被引入，并已单独或联合使用。采用栓塞术是为了避免急诊手术的高风险。通过引入各种栓塞术可实现完全止血并延长疗效。自1983年1月引入所有这些栓塞术以来，未进行过急诊手术。接受联合栓塞术的急诊病例的止血率（100%）、1个月生存率（90%）、1年再出血发生率（6.7%）、1年生存率（75.5%）和3年生存率（62.5%）均优于仅接受急诊手术或内镜硬化治疗的病例。此外，包括接受各种联合栓塞术治疗的出血性胃静脉曲张患者在内的胃静脉曲张患者，78.9%的患者静脉曲张缩小。因此，为提高长期控制出血的耐久性，应根据患者的血流动力学情况联合使用栓塞术，这可能会扩大其应用范围。
