摘要
目的评价介入断流术与外科断流术治疗肝硬化门静脉高压症食管胃底曲张静脉出血的临床效果。资料与方法一组为介入科对73例经临床诊断为肝硬化门静脉高压性曲张静脉出血的患者,作经皮穿刺曲张静脉硬化栓塞和部分性脾动脉栓塞治疗。另一组为肝胆外科对98例门静脉高压症患者,行外科断流术。比较两组术后反应和并发症;以及住院时间和治疗费用;追踪随访术后肝功能、复发出血情况和生存状态;首次出血时间和生存时间。结果(1)介入断流术的并发症:发热(76.9%)、腹痛(58.5%)、腹胀(35.4%),无严重并发症发生;外科断流术术后并发症:死亡(3.1%),呕血或黑便(7.1%),门静脉血栓形成(18.4%),感染包括脓肿、败血症(5.1%)等;(2)介入断流术1、2、3、4、5年的累计复发出血率分别为:18.46%、29.23%、35.38%、38.46%、38.46%;累计生存率分别为:93.85%、90.77%、86.15%、83.08%、81.53%。外科断流术1、2、3、4、5年的累计复发出血率分别为:27.36%、36.72%、42.58%、45.67%、48.93%;累计生存率分别为:79.63%、75.48%、72.32%、70.15%、69.68%。结论介入断流术治疗门静脉高压曲张静脉出血设计合理、操作简单安全,止血效果明确,尤其适合肝功能B级和C级患者的止血治疗。可改善患者生存质量,延长生存时间。
Objective To evaluate the clinical effect of treatment in patients with cirrhotic PHT by intervertional devaseularizafion and surgical devaseularization. Materials and Methods 73 eases of bleeding patients with liver cirrhosis and PHT were selected by department of the interventional radiology, treatment method included pereutaneous transhepatie obliteration （ PTO ） and paritial splenic embohzation （ PSE ） . 98 eases of patient with liver cirrhosis were treated by surgical devaseularization. Postoperative reetion , complications , length of stay , care cost, rebleeding time and survival quality after the procedure, and relevant factors of postoperative rebleeding, rebleeding time and survival time, hepatic function between two methods were compared. Results ①The main eomplietion of Intervertional devaseularization were fever （ 76.9% ） ,bellyache （ 58.5% ） ,abdominal swelling （ 35.4% ） ,there was no serious complication. The main complication of surgical devaseularization were the death （ 3.1% ） ,melena （ 7.1% ） ,portal vein thrombosis （ 18.4% ） , Infection include abscess and septicemia （ 5.1% ） . ② After intervertional devaseularization the 1 , 2 , 3 , 4 , 5 year cumulative survival rates and rebleeding rates were 18.46% ,29.23 % ,35.38% , 38.46% ,38.46% and 93.85% , 90. 77% , 86.15% , 83.08% , 81.53% respectively. After surgical devaseularization the 1 , 2 , 3 , 4 ,5 year cumulative survival rates and rebleeding rates were 27.36% , 36.72% , 42.58% , 45.67% , 48.93% and 79.63% , 75.48% , 72.32% , 70.15% , 69.68% respectively. Conclusion The intervertional devaseularization procedure is suitable,simple and safe method to prevent form rebleeding, especially for liver ruction Child - pugh B or C degree , it can improve liver ruction and prolong the survival time for the later stage of cirrhotic PHT.
出处
《临床放射学杂志》
CSCD
北大核心
2007年第7期712-716,共5页
Journal of Clinical Radiology
关键词
门静脉
高血压
肝硬化
食管静脉曲张
介入断流术
出血
Portal vein Hypertension Liver cirrhosis Esophagogastrie variee Intervertional devaseularization Hemorrhage
