部分脾动脉栓塞术联合内镜治疗门脉高压症合并中重度食管胃静脉曲张破裂出血的疗效分析

目的　研究内镜下食管静脉曲张套扎术（EVL）、胃静脉曲张硬化术（GVS）联合部分脾动脉栓塞术（PSE）对门脉高压症（PH）合并中重度食管胃静脉曲张（EGV）破裂出血的疗效、安全性及经济性。方法　纳入92例有明确EGV出血的肝硬化PH的住院患者。43例接受EVL/GVS联合PSE治疗为观察组，49例患者接受EVL/GVS治疗为对照组。比较2组患者中重度EGV的根治率、复发率、再出血率、住院天数、安全性及住院总费用。结果　观察组、对照组第1、3个月在EGV根治率、复发率、再出血率方面差异均无统计学意义（均P＞0.05）。第6、12个月观察组EGV根治率显著高于对照组（均P＜0.05），复发率和再出血率显著低于对照组（均P＜0.05），观察组住院总费用（万元：8.97 vs. 13.77）、住院总天数（d：27.0 vs. 43.0）显著低于对照组（均P＜0.01）。PSE常见并发症为发热、腹痛、腹腔积液、腹腔感染，严重并发症为脾脓肿。结论　内镜套扎、硬化联合部分脾动脉栓塞术治疗门脉高压症合并中重度EGV破裂出血中长期疗效与单纯内镜套扎、硬化术相比有较高的根治率，较低的复发率、再出血率、住院总费用及住院总天数。PSE并发症可控。

Clinical analysis of partial splenic artery embolization combined with endoscopic variceal ligation in the treatment of portal hypertension complicated with moderate-severe esophageal and gastric variceal bleeding

Objective　To investigate the efficacy, safety and economy of endoscopic esophageal variceal ligation (EVL), gastric variceal sclerotherapy (GVS) combined with partial splenic embolization (PSE) for the treatment of moderate-severe esophageal and gastric varices (EGV) bleeding with portal hypertension (PH). Methods　Ninety-two hospitalized PH patients with definitely EGV bleeding history were recruited. Forty-three patients who received EVL/GVS combined with PSE were included in the observation group, and 49 patients received EVL/GVS alone were used as the control group. Data of the effects of operation on the cure rate, recurrence rate, re-bleeding rate, hospitalization days, safety and total cost of hospitalization in moderate-severe EGV patients were compared between the two groups. Results　There were no significant differences in the radical cure rate, recurrence rate and re-bleeding rate at the first and the 3rd month of treatment between the two groups (all P＞0.05). The radical cure rates of EGV were higher in the observation group than those in the control group at the 6th and 12th month (all P＜0.05). The recurrence rate and re-bleeding rate were significantly lower in the observation group than those in the control group (all P＜0.05). The total hospitalization expenses (unit:ten-thousand-yuan) and the total hospitalization days (unit:day) were both significantly reduced in the observation group (8.97 vs. 13.77, P＜0.01 and 27.0 vs. 43.0, P＜0.01) than those in the control group. Common complications of PSE were fever, abdominal pain, ascites, hydrothorax, abdominal infection, and the most serious complication was splenic abscess. Conclusion　The combination treatment of PSE and EVL/GVS shows better long-term efficacy in radical cure rate, notable lower recurrence rate, re-bleeding rate, total hospitalization costs and hospital stays than EVL/GVS alone for PH patients with moderate-severe esophageal and gastric variceal bleeding. The complications of PSE are controllable.