| Portal hypertension of hepatic cirrhosis is common disease,companied with hypersplenism esophagus and fundus gastricus varication and hypersplenia usually. And it is the main dead reason. So it is an important study on how to cure the varicose bleeding of the hypersplenism esophagus and fundus gastricus varication and control the hematocytopenia caused by hypersplenia in order to improve the life span and quality.Recent years, some therapeutic effects have acquired by the intervention technique, but it also has some limitations. We have satisfactory therapertic effects by combining theory of the partial splenic embolization(PSE)and PVTE to cure 43 patients with portal hypertension.Venepuncture and PVTE were performed succeeded. The successful haemostasis rate was 100% postoperatively. All cases were alive. After operations, we did the gastroscopy and found that among the hypersplenism esophagus and fundus gastricus varication cases: vanished cases12, mild varicated cases 23, and vanished cases 8 after the barium meal X-ray test. The red blood cell count, white blood cell count and platelet count were higher, but the red cell count become normal within 6 months and the white cell and platelet count took 3 months. Hepatic function was improved to some different degree in the sixth month in all the patients after the interventional therapy, and we found that the albumin , total bilirubin,alanine aminotransferase were improved than preoperation. There was no xenotope embolism, splenic abscess,splenic rupture in all the cases,and combined therapy was used after operations.We reviewed 43 cases with their total clinical history from preoperative diagnosis to the follow up, and we also did the statistical analysis with the biochemical examination results before and after operations. We investigated the clinical effect of PTVE on the emergent hemostasis after the upper gastric hemorrhage because of the portal hypertension with liver cirrhosis and the decrease of the platelet counting, RBC counting, WBC counting after the PSE on the hypersplenism because of the portal hypertension with liver cirrhosis. We found the advantages and disadvantages of different methods, for example endoscopic varicose vein ligation, surgery, medical conservative treatment, and TIPSS, after the systematic comparison on the complete clinical effect, postoperative complications and unexpected situations during operations. We found that the one-year re-hemorrhage was 34.9%, the short-term clinical effect was obvious, and the long-term clinical effect was still better than endoscopic varicose vein ligation. PSE and surgery had similar clinical effect, because the improvement of RBC, WBC and platelet had no statistical significance. PVTE combined with PSE compared with TIPSS, TIPSS solved the portal hypertension with liver cirrhosis completely, but it had the restenosis and the hepatic encephalopathy would occurred easily, and the difficulties of the operation and the cost were much higher.According to the comprehensive therapy, PVTE combined with PSE was a conservative treatment because the reasons of the portal hypertension with liver cirrhosis was not solved. It was only a symptomatic treatment, so it had the possibility of re-hemorrhage. As each method had its own advantages and disadvantages, and the portal hypertension with liver cirrhosis was a refractory disease, we should select the most proper therapy method with other management to decrease the anguish, prolong survival time and improve the living quality.The combination of PSE and PVTE to cure patients with portal hypertension hypersplenism and bleeding of rupture of esophagus and fundus gastricus varication could decrease the opportunities of rehemorrhage, and preserve the function of spleen. It had the advantages of convenient,microinvasive, safe, effective, lesser complications. It was an ideal therapeutic method to manage patients who couldn't bear the surgery, emergencent alimentary tract hemorrhage internal medicine failed. |
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