Abstract:Objective:To study the effect of combination of esophageal varices and spleen interventional embolization for portal hypertention with gastroesophageal variceal bleeding.
Methods :A comparative study was done as follows: In treatment group, percutaneous transhepatic variceal embolization with TH glue combined with partial splenic embolization was performed in 66 patients with cirrhotic portal hypertension; in control group, 54 patients were treated by devasculization and subtotal splenectomy with retroperitoneal splenic transposition . The follow-up period ranged from 2 to 60 months ( averages 20 months).
Results:(1)In treatment group ,the rates of emergency control of hemorrhage and rebleeding was 100% and 3.3% respectively. In the control guoup, the rate of rebleeding was 4.8%.(2) In the treatment group, at 2 months and 1 year postoperation, PHG was unchanged compared with that of preoperation. In the control group, at 2 months postoperation, PHG was significantly aggravated compared with that of preoperation（P＜0.05）, but at 1 year postoperation, PHG was significantly improved compared with that of preoperation (P＜0.05). There was no significant difference between the two groups in change of PHG (P＞0.05). (3) In the treatment group, the rate of disappearance, improvement, absence and aggravation change of G-E varices was 20.4%, 59.3%, 18.3%, and 1.8% , respectively, and in the control group, the varices disappearance rate was 20%, improvement rate 52%, and absence rate 28%. There was no significant difference between the two groups (P＞0.05). (4) Free pressure of portal vein (FPP) significantly declined at post-operation in the two groups （P＜0.05）. In the treatment group, average decline of FPP was (2.55±6.93) cmH2O, and in the control group it was (2.46±7.07) cmH2O.
Conclusions:Combined interventional embolization has the advantages of controlling variceal hemorrage and decreasing portal venous pressure, and does not aggravate PHG. The result shows that this method possessed an effect similar to that of subtotal splenectomy with retroperitonal splenic transposition and devascularization.