L'Herminé C, Chastanet P, Delemazure O, Bonnière P L, Durieu J P, Paris J C
Department of Radiology, Centre Hospitalier Universitaire, Lille, France.
AJR Am J Roentgenol. 1989 Apr;152(4):755-60. doi: 10.2214/ajr.152.4.755.
During a 7-year period, bleeding esophageal varices were treated by means of percutaneous transhepatic embolization in 400 cirrhotic patients, including 258 patients with Child's class C cirrhosis (65%) and 142 patients with Child's class B cirrhosis (35%). Embolization was performed either with bucrylate or with absolute ethanol and stainless-steel coils. Variceal hemorrhage was controlled in 245 (83%) of the 297 patients in whom percutaneous transhepatic embolization was performed as an emergency treatment. The 10-day survival rate in the series was 76%, with 97 deaths occurring shortly after the procedure as a result of recurrent bleeding or liver failure. The actuarial rate of recurrent bleeding was 55% at 6 months (38% Child's class B, 70% Child's class C) and 81% at 2 years (71% Child's class B, 90% Child's class C). One-half the cases of recurrent bleeding were easily controlled by medical treatment; 56% of these patients were still alive at 6 months (79% Child's class B, 42% Child's class C), 48% were alive at 1 year, and 26% were alive at 5 years. Results indicated that the survival rate was significantly higher (p less than .01) in Child's class B patients than in Child's class C patients during the 5-year follow-up period. The overall technical failure and complication rates were 9% and 7%, respectively, but these rates declined progressively as we gained more experience with the procedure. In this large series, transhepatic embolization was a safe, easy-to-perform, and effective treatment for the control of variceal bleeding and was somewhat more efficacious than previously reported.
在7年期间，400例肝硬化患者接受了经皮肝穿刺栓塞术治疗食管静脉曲张出血，其中Child C级肝硬化患者258例（65%），Child B级肝硬化患者142例（35%）。栓塞剂使用的是氰基丙烯酸正丁酯或无水乙醇加不锈钢圈。297例将经皮肝穿刺栓塞术作为急诊治疗的患者中，245例（83%）的曲张静脉出血得到控制。该系列患者的10天生存率为76%，97例患者在术后不久因再次出血或肝功能衰竭死亡。6个月时再出血的精算率为55%（Child B级为38%，Child C级为70%），2年时为81%（Child B级为71%，Child C级为90%）。一半的再出血病例通过药物治疗很容易得到控制；这些患者中，6个月时56%仍存活（Child B级为79%，Child C级为42%），1年时48%存活，5年时26%存活。结果表明，在5年随访期内，Child B级患者的生存率显著高于Child C级患者（p<0.01）。总体技术失败率和并发症发生率分别为9%和7%，但随着我们对该操作经验的增加，这些比率逐渐下降。在这个大样本系列中，经皮肝穿刺栓塞术是一种安全、易于操作且有效的控制曲张静脉出血的治疗方法，其疗效比先前报道的略好。
