Ultrasound-guided percutaneous coronary embolization through hepatic portal vein for the prevention and treatment of upper gastrointestinal bleeding: 2 cases and literature review
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摘要: 食管胃底静脉曲张作为肝硬化患者门静脉高压的常见且最危险的并发症之一，程度严重时是发生上消化道出血的独立危险因素，其病死率高、进展快、易反复出血。目前食管胃底静脉曲张的治疗主要包括内镜下治疗、经颈静脉肝内门体分流术、外科手术、药物治疗等；此外，超声引导下经皮经肝门静脉实施胃冠状静脉栓塞防治这项新兴技术止血作用持久而更彻底，患者耐受更好。超声和数字减影血管造影多学科合作，可望在预防和治疗门脉高压食道胃底静脉曲张破裂的上消化道大出血发挥重要作用。Abstract: As one of the most common and dangerous complications of portal hypertension in patients with cirrhosis, esophageal and gastric varices (EV) is an independent risk factors for upper gastrointestinal bleeding when they are severe, with high fatality rate, rapid progression and easy repeated bleeding. Currently, the prevention and treatment of cirrhosis esophageal gastric varices treatment mainly includes endoscopic treatment, TIPS, surgery, Pharmacological, etc. In addition, Ultrasound guided percutaneous transhepatic portal vein embolization is a new technique for the prevention and treatment of gastric coronary vein thrombosis. The hemostasis effect is lasting and more thorough, and the patients are better tolerated. The multidisciplinary cooperation between ultrasound and DSA is expected to play an important role in the prevention and treatment of massive hemorrhage of upper digestive tract caused by portal hypertension esophagogastric varicose vein rupture.
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图 1 彩超显示门脉穿刺置管术中
Figure 1. Color ultrasound showed the portal vein puncture catheterization.
图 2 术前门静脉CTV显示胃左静脉迂曲
Figure 2. Portal vein CTV before operation showed tortuosity and dilation of the left gastric vein.
图 3 术后门静脉CTV显示胃左静脉被弹簧圈栓塞后已堵塞
Figure 3. Portal vein CTV before operation showed the left gastric vein was blocked by a coil embolization.
图 4 术后门静脉CTV显示胃左静脉不显影
Figure 4. Portal vein CTV before operation showed the left gastric vein was not developed.
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