闭式胃冠状静脉栓塞术的疗效与技术要点
安东均
摘 要
本文报告采用闭式胃冠状静脉栓塞术治疗32例门静脉高压症的效果，并对其手术要点进行讨论。该术式在结扎胃冠状静脉主干的同时结扎胃右静脉、胃网膜右静脉及胃后静脉，于贲门上下各5cm以远的食管和胃体以及肝胃韧带夹持无损伤钳，从而使被栓塞的胃冠状静脉区域呈封闭状态，再从胃冠状静脉远肝侧主干推注TH胶，有效地防止了异位栓塞。本组同时行脾切除术31例，其中3例加作了脾肾静脉分流术；1例未作脾切除附加了肠系膜上静脉-下腔静脉分流术。11例急症栓塞后全部即刻止血，治愈10例，1例死于术后肝功能衰竭。择期手术者均好转、痊愈。无1例发生异位栓塞。随访6月～8年，术后远期再出血率10%。
关键词
食管和胃静脉曲张；栓塞，治疗性；手术研究
THE EFFECT AND MAIN POINTS OF CLOSED GASTRIC CORONARY VEIN EMBOLIZATION
An Dongjun
（Department of Hepatobiliary Surgery，the Second People's Hospital of Xianyang，Shanxi，712000）
ABSTRACT
Since April 1987，32 patients with portal hypertension were treated by closed gastric coronary vein embolization with TH glue（α-cyanoacrylate）in our hospital.The effects of the treatment and the main points of the operative method were reported here.The improvement of the operative method to avoid ectopic embolism consists:（1）The dose of TH glue depends on the degree of the dilatation of the gastric coronary vein and the esophageal varices.generally in 8-12m1.（2）Ligation of the main gastric coronary vein with ligation of the right gastric and gastroepiploic veins in addition.（3）The esophagus and the veins around it must be temporarily obstructed when the TH glue is injected into the gastric coronary vein，the gastric body and upper hepatogastric ligament should be obstructed at the same time.None of the series had suffered from ectopic embolism.One case died of liver failure after the operation.The others were followed up for 6～96 months，distant rehemorrhage rate was 10%.
KEY WORDS
esophageal and gastric varices；embolization，therapeutic；operations research
闭式胃冠状静脉栓塞术系指在胃冠状静脉栓塞术［1］的基础上附加了一些手术步骤，从而使被栓塞的胃冠状静脉区域呈封闭状态，与门静脉和体静脉间的侧支反流完全阻断，有效地防止了异位栓塞等严重并发症的发生。我科自1987年4月以来采用该术式治疗32例门脉高压症，本文就其近、远期疗效与技术要点报告如下。