部分脾动脉栓塞术联合食管静脉曲张套扎术用于肝硬化食管静脉曲张出血的二级预防临床效果

摘要

Objective:To evaluate the effects of endoscopic variceal ligation ( EVL) combined with partial splenic artery embo-lization( PSE) on the secondary prevention of endoscopic variceal bleeding in patients. Methods:78 patients with endoscopic variceal bleeding from June 2012 to May 2013 were divided into two groups:EVL alone,EVL combined with PSE. endoscopic variceal eradica-tion rate,recurrence rate,rebleeding rate,WBC count,platelet count,splenic vein diameter and portal vein diameter were compared. Re-sults:Compared with EVL,the late rebleeding rate was significantly lower in combination therapy group(P<0. 05) . The recurrence and early rebleeding rate had no difference(P>0. 05). The WBC and platelet counts were higher in combination therapy group(P<0. 05). Diameter of portal vein and splenic vein of two group were no difference (P >0. 05). Conclusion:Compared with the EVL,EVL com-bined with PSE has better medium and long-term effects on the secondary prevention of endoscopic variceal bleeding,especially higher counts of WBC and platelets,higher eradication rate,lower late rebleeding rate.%目的：：评价部分脾动脉栓塞术( partial splenic artery embolization,PSE)联合内镜下食管静脉曲张套扎术( endo-scopic variceal ligation,EVL)用于肝硬化食管静脉曲张出血的二级预防的临床效果。方法：回顾我院2012年6月至2013年5月诊断肝硬化食管静脉曲张破裂出血78例患者,比较PSE联合EVL和单纯EVL食管静脉曲张根治率、复发率、再出血率、血白细胞、血小板、脾静脉直径、门静脉直径。结果：联合治疗在食管静脉曲张根治率、晚期再出血率显著低于单纯套扎,但在食管静脉曲张复发率和早期再出血率没有差异。联合治疗明显改善患者外周血白细胞、血小板数量,提高患者免疫力和止血能力,有统计学意义(P<0．05)。虽然联合治疗缩小门静脉直径、脾静脉直径,但没有统计学意义(P>0．05)。结论： PSE联合EVL治疗食管静脉中远期疗效较单纯EVL更佳,有更高的根治率、白细胞及血小板,更低的晚期再出血率。