Tianjin Medical Journal

Tianjin Medical Journal ›› 2020, Vol. 48 ›› Issue (11): 1082-1086.doi: 10.11958/20200324

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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

XU Bai-guo1, WANG Feng-mei2△, HAN Tao1, LI Jun1   

  1. 1 Department of Hepatology and Gastroenterology, the Third Central Clinical College of Tianjin Medical University, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China; 2 Department of Hepatology, the Second People's Hospital of Tianjin
  • Received:2020-02-24 Revised:2020-08-28 Published:2020-11-15 Online:2020-11-15

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Abstract: 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.

Key words: liver cirrhosis, esophageal and gastric varices, gastrointestinal hemorrhage, ligation, sclerotherapy, esophageal variceal ligation, gastric variceal sclerotherapy, partial splenic embolization