摘要
目的采用多层螺旋CT随访观察改良的经皮经肝组织胶(TH)栓塞治疗食管静脉曲张术(PTVE)的远期疗效。方法 2005年10月至2012年1月收治肝硬化患者156例,行PTVE治疗。采用螺旋CT观察曲张静脉栓塞术前后的变化。术后3、6、12个月及以后每年行上腹部CT扫描随访。结果156例均穿刺、栓塞成功。根据TH胶栓塞范围,将患者分为三组,完全栓塞组82例,即TH胶至少栓塞食管下段5 cm以上食管曲张静脉、食管旁及食管周围静脉丛,胃底曲张静脉;部分栓塞组49例,TH胶栓塞胃底贲门曲张静脉,但未栓塞食管下段曲张静脉;静脉主干组25例,TH胶仅到达胃冠状静脉及胃左静脉组,未达胃底及贲门曲张静脉。随访期间再出血36例,总出血率为23.1%(36/156)。其中完全栓塞组再出血7例,再出血率8.5%(7/82);部分栓塞组再出血11例,再出血率为22.4%(11/49);静脉主干组再出血18例,出血率为72%(18/25)。三组间再出血率差异有统计学意义(P=0.000)。结论 TH胶的栓塞范围及程度对治疗和预防静脉曲张复发、维持远期疗效具有重要意义,多层螺旋CT能对PTVE术栓塞疗效评价提供临床指导。
Objective By using multi- detector row computed tomography angiography （CTA） to observe the long- term effectiveness of percutaneous transhepatic variceal embolization （PTVE） with cyanoacrylate for the treatment of bleeding due to esophageal varices. Methods During the period from Oct. 2005 to Jan. 2012, a total of 156 patients with cirrhosis complicated by esophageal varices were treated with PTVE using cyanoacrylate as embolic agent. Spiral CTA was performed before and after the procedure in all patients in order to observe the pathologic changes. At 3, 6 and 12 moths after the treatment follow-up CT scanning of the upper abdomen was conducted, and after that CTA was carried out once a year. The results were analyzed. Results Technical success, including puncturing and embolization management, was obtained in all 156 patients. According to the embolization extent, the patients were divided into three groups： group A （complete embolization group, n = 82）, group B （partial embolization group, n = 49） and group C （venous trunk embolization group, n = 25）. In group A, the embolization extent covered at least 5 cm segment of the lower esophageal varices, the para-esophageal as well as peri-esophageal varices, and thevarices of gastric fundus. In group B, the obstructed range included the varices surrounding the gastric cardia and fundus as well as their feeding vessels, but the lower esophageal varices was not obliterated.Ingroup C, only the gastric coronary vein andleft gastric vein were blocked, while the varices surrounding the gastric cardia and fundus were unaffected. During the follow-up period, recurrent bleeding was seen in 36 patients, with a total bleeding recurrence of 23.1% （36/156）. Of the 36 patients with recurrent hemorrhage, seven were in group A （8.5%, 7/82）, 11 in group B （22.4%, 11/49） and 18 in group C （72.0%, 18/25）. The differences in the bleeding recurrence among the three groups were statistically significant （P = 0.000）. Conclusion The embolization extent and degree of cyanoacrylate is of great value in treating esophageal varices, preventing its recurrence and in maintaining the long-term therapeutic effectiveness. Multi-detector row computed tomography angiograpby can correctly evaluate the effect of PTVE, which is very helpful in guiding clinical management.
出处
《介入放射学杂志》
CSCD
北大核心
2013年第4期288-291,共4页
Journal of Interventional Radiology
基金
山东省科技攻关项目资助(2010G0020241)
关键词
食管静脉曲张
多层螺旋CT
组织胶
栓塞
esophageal varices
multi- detector row spiral computed tomography
cyanoacrylate
embolization
