【作者】 王珊丹；

【导师】 张春清；

【作者基本信息】 山东大学 ， 内科学， 2010， 硕士

【摘要】 目的：动态观察经皮经肝曲张静脉栓塞后食管胃底粘膜下曲张静脉、食管旁静脉和食管胃底周围静脉丛内组织胶的滞留和转归,探讨经皮经肝组织胶栓塞后食管下段和胃底部不同部位曲张血管丛组织胶的转归特点,从而明确经皮经肝组织胶介入栓塞的远期疗效机制。方法：自2003年经皮经肝栓塞食管胃静脉曲张病人130例。其中22例于术后1-2周、2周-1月、1月-3月、6月及以后每年行动态胃镜检查并于术后3月、半年及以后每年复查上腹部CT和门静脉血管成像。本研究即是通过该22例动态随访病人的胃镜及CT结果,分析介入栓塞后食管下段和胃底部粘膜下曲张静脉丛、壁内穿支静脉及壁外周围静脉丛组织胶转归和演变特点。结果：该22例患者动态随访47-62个月,平均56个月。胃镜复查示术后1-2周,22例患者可见食管下段被TH胶填充的曲张静脉呈条索状,质地变硬,可见其内有白色或棕褐色组织胶沉积,曲张静脉壁呈肿胀、糜烂、溃疡等炎症反应的表现,2例病例可见组织胶的少量脱失,未被TH胶栓塞的食管中上段曲张基本静脉消失或明显缓解。术后2周-1月的复查,21例可见黏膜表面呈花斑状,曲张静脉呈灶状溃疡及脱胶,但可见明显的结节样增生,被组织胶填充的上段静脉曲张消失或呈F1表现。术后1-3个月的复查,20例患者可见粘膜炎症基本消退,有少量黑色组织胶被排除,周围粘膜光滑,部分粘膜仍有颗粒感,无曲张静脉及组织胶沉积于粘膜下,或是已无组织胶排泄,只剩下黏膜下斑点状棕色组织胶沉积,静脉曲张消失或呈F1走直表现,9例病人食管下段粘膜出现表浅毛细血管,走形紊乱。术后半年,15例食管下段及胃底部粘膜光滑,无组织胶沉积及排除,静脉曲张持续稳定,食管粘膜颗粒感,粘膜下表浅纤细血管常见,粘膜无明显充血、水肿和糜烂,剩余7例胃底粘膜光滑,无组织胶沉积,而食管下段黏膜下仍有斑点状棕色组织胶沉积。术后47月-62月术后强化CT显示该组病人食管下段及胃底贲门区域粘膜下曲张静脉、胃底部穿支静脉、食管下段胃底周围静脉及旁静脉组织胶栓塞广泛,术后动态CT随访观察显示食管下段及胃底部粘膜下曲张静脉内组织胶逐渐脱落、减少,而食管下端和胃底周围静脉及穿支静脉内组织胶持续密实充填,未随时间延长而脱落、减少,腹腔内其他部位也未见有组织胶残留；动态门静脉血管成像观察显示血管栓塞充分,曲张静脉栓塞区域无血流信号,无明显血管再通表现。结论：经皮经肝组织胶曲张静脉栓塞后食管下段和胃底粘膜下的曲张静脉出现排胶现象且静脉曲张消失；而食管下段食管旁静脉和周围静脉、胃底和贲门周围曲张静脉、胃壁内穿支静脉内组织胶充填良好,术后随访未见组织胶脱失和减少。不同部位血管丛内组织胶转归不同,不能简单的用“异物排胶”理论解释,可能与胃酸的腐蚀及食物的冲刷及其他原因相关,但还需要大量的动物实验及病理结果来证实。食管胃底周围静脉及胃底部穿支静脉内组织胶的长久栓塞和滞留是预防静脉曲张复发、保持介入栓塞持久疗效的基础和保障。更多还原

【Abstract】 Objective:To evaluate the prognosis of the TH glue and the prostecditive efficacy after percutaneous transhepatic varices embolizationby endoscopy and CT scanning.Methods:TH glue was injected into esophageal and gastric varices and their feeder veins in130 patients.106 patients were followed-up for evaluating the rate of re-bleeding,and 22 patients of their were followed-up for endoscopy and CT. These 22 patients need endoscopy at 1 to 2 weeks,2 to 4 weeks,1month to 3 months and 6 months after the procedure,and need CT at 3 months and 6-12 months after the procedure.Results:The endoscopy was performed at 1-2 weeks(no changes,no Foreign Body Batchingout.),2-4weeks (21 patients’mucosa turning to ulcer and appear Foreign Body Batchingout,or F1 appearance, 1patient no change), 1-3month(the black TH glude of 20 patients’ mucosa turning to be out and the mucosa turning smooth,the varices turn to disappear or F1), and 6 months after the procedure(the esophageal and gastric mucosa of 15 patients were smoonth,no TH glue,but the esophageal mucosa of 7 patients were pigmentation macularis multiplex),by the CT performed at 3 months and 6-12 months after the procedure,we know that the TH glue in the esophageal and gastric varices decreased, while the TH glue kept staying in the paraesophageal veins and para-gastric fudus veins during the follow-up. And no vessel recurrent. Conclusion:The TH glue in the esophageal and gastric varices decreased, while the TH glue kept staying in the paraesophageal veins and para-gastric fudus veins during the follow-up. This result can’t be explained completely by Foreign Body Batchingout. The inflammation and fibrosis of esophageal and gastric mucosa is the premise of disappearing of varies. while the TH glue kept staying in the paraesophageal veins and para-gastric fudus veins prevent rebleeding. The relapse rate after percutaneous transhepatic varices embolization is closely related to obliteration range.更多还原