经皮经肝食管胃底静脉栓塞术治疗肝硬化合并上消化道大出血的临床疗效观察

摘要

目的：观察肝硬化合并上消化道大出血患者采取经皮经肝食管胃底静脉栓塞术治疗的临床疗效。方法回顾性分析本院2011年9月至2012年5月采取经皮经肝食管胃底静脉栓塞术治疗的27例肝硬化合并上消化道大出血患者（术前肝功能评价均为Child-Pugh C级）的临床资料，观察其再出血率、肝功能变化情况、肝性脑病发生率、术后2年生存率、食管胃底静脉曲张程度的改变。结果经皮经肝食管胃底静脉栓塞术治疗肝硬化合并上消化道大出血手术成功率为100.0%，止血率为100.0%，1例患者术后次日因呼吸衰竭死亡。患者平均门静脉压力由术前（19.9±3.2）mmHg升至术后（22.7±4.7） mmHg，差异具有显著性（P＜0.05）。患者平均随访时间为（27.4±3.6）个月，随访期间再出血率为26.9%（7/26），肝性脑病发生率为15.4%（4/26），术后2年生存率为84.6%。患者肝功能在术后3、6、12个月Child-Pugh评分下降，白蛋白水平上升，差异具有显著性（P＜0.05）。结论经皮经肝食管胃底静脉栓塞术治疗肝硬化合并上消化道大出血能够及时止血，且患者术后再出血率、肝性脑病发生率较低，术后2年生存率较高，术后肝功能得到改善。经皮经肝食管胃底静脉栓塞术是治疗肝硬化合并上消化道大出血安全有效的方法，具有重要的临床应用价值。%Objective To observe hepatocirrhosis with upper gastrointestinal hemorrhage patients take percutaneous by liver stomach esophagus vein embolization clinical curative effect. Method The clinical information of 27 patients were retrospectively analyzed in our hospital from September 2011 to May 2012, whom with hepatocirrhosis with massive hemorrhage of upper gastrointestinal tract (preoperative evaluation of liver function are all Child-Pugh C level) to percutaneous by liver stomach esophagus vein embolization, observed the bleeding rate and liver function changes again, the incidence of hepatic encephalopathy, 2 years survival rate, the change of the degree of esophageal gastric varices. Result Percutaneous by liver stomach esophagus vein embolization hepatocirrhosis with massive hemorrhage of upper gastrointestinal tract surgery success rate was 100.0%, the bleeding rate was 100.0%, 1 case died of respiratory failure day later. Patients with an average of portal vein pressure rose from preoperative (19.9±3.2) mmHg to postoperative (22.7±4.7) mmHg, which was signiifcant difference (P<0.05). Patients with an average time of follow-up was (27.4±3.6) months follow-up period to hemorrhage rate was 26.9%(7/26), the incidence of hepatic encephalopathy was 15.4%(4/26), postoperative 2 years survival rate ofter surgery was 84.6%. Liver function in patients with postoperative 3, 6, 12 months Child-Pugh score declined, albumin levels rose, with signiifcant difference (P < 0.05). Conclusion Percutaneous by liver stomach esophagus vein embolization hepatocirrhosis with massive hemorrhage of upper gastrointestinal tract can timely hemostasia, and patients with postoperative rebleeding rate and low incidence of hepatic encephalopathy, 2 years survival rate after surgery is higher, liver function improved after surgery. Percutaneous liver stomach esophagus vein embolization is safe and effective for the treatment of hepatocirrhosis with upper gastrointestinal hemorrhage in the method, has important value of clinical application.