[关键词]  门静脉高压 上消化道出血 胃冠状静脉栓塞术 部分脾动脉栓塞术

　　Therapeutic  effects  of  double  Interventional  radiology  treat  the portal hgpertention upper gasteroin testinal hemorrhage of hepatic cirrhosis

　　DU Zi-zhong . Gao Xiao-ping . Zhang bao-zhou Guole-yan Shen zheng-gao Department  of  Radiology  ,Lanzhon  Electric  Corporation Hospital  ,Gansu  Province  730050

　　ZHANG Zhi-yong  CHEN  Ze Department  of Radiology  ,Gansu  Provincial  ,Tumor  Hospital.  Lanzhou,730050

　　[ABSTRACT] Objective:To explore the effect of percutaneous transhepatic variceal embolization of gastroesophageal varices,combined with Partial splenic embolization devascularization(PTVE+PSE) in the treatment of Portal hypertention upper gastrointestinal hemorrhage.Methods:A total of 122 cases of hepatic cirrhosis combined with hypersplenism were operated.Advanced,gastroesophageal varices and vein gastric breves were embolism,then partial splenic artery were embolism,it observed portal vein pressure variety in the operation;the gastroesophageal revarices,the incidences of rebleeding,death,the improvement of splenemagly and complications were observed in the cases after PTVE and PSE.Results:122 cases operated successfully, the portal vein pressure descent from 30.8±2.77mmH2O to 25.92±2.14mmH2O，the degree of gastroesophageal varices were improved obviously.Conclusion:PTVE combined with PSE is safe,reasonable and effective for gastroesophageal varices,it deserve the clinical application expansion.

　　[KEY WORDS] Portal hypertention ;upper gastrointestinal hemorrhage; Percutaneous transhepatic variceal embolization;Partial splenic embolization devascularization

　　 经皮肝穿胃冠状静脉栓塞术是经皮肤、肝脏穿刺至肝内门静脉分支,选择性地进行胃冠状静脉插管,用栓塞材料闭塞血管,达到治疗食管胃静脉曲张出血的一种介入性治疗方法,是控制食管胃底静脉曲张大出血的一种有效的非手术止血方法。门静脉高压症脾肿大严重者往往有脾功能亢进,部分性脾栓塞治疗可作为脾切除手术的替代疗法,又可保持脾脏所具有的功能。1999年11月至2008年2月本中心将二者联合应用即双介入治疗122例资料完整的肝硬化门静脉高压症（CPH）病人,效果满意,报告如下：

　　材料与方法

　　一.一般材料

　　1999年11月至2008年2月，对122 例资料完整的肝硬化门静脉高压伴脾功能亢进的患者行经皮肝穿胃冠状静脉及部分脾动脉栓塞术 。男73例，女49例，年龄23岁至75岁，平均43.5岁。均经ＣＴ、胃镜、钡餐、Ｂ超及实验室检查,证实为肝硬化胃底、食道静脉曲张及脾功能亢进。其中113例有出血史（出血1～2次，出血量200～1 600 ml/次），其中68例以出血为首发症状急诊入院。均有不同程度的低蛋白血症、腹水、贫血、黄疸等情况而不适合外科手术治疗或病人拒绝外科手术。临床症状：122例患者均有不同程度疲倦、衰弱无力，食欲减退，恶心。其中13例有腹泻症状。钡餐或胃镜检查120 例有食道胃底静脉曲张。实验室检查：术前白细胞