Abstract: Background　The patients with hepatic cirrhosis combined with hypersplenism and esophageal and gastric varices bleeding（EGVB） should undergo partial splenic artery embolization（PSE） after emergent endoscopic and medical treatment due to the leukocytopenia，thrombocytopenia，clotting factor reduction，coagulopathy，large volume of bleeding，and high incidence of rebleeding.Objective　To evaluate the effects of endoscopic treatment（ET） combined with PSE on the patients with hepatic cirrhosis combined with hypersplenism and EGVB.Methods　A total of 158 hospitalized patients with hepatic cirrhosis combined with hypersplenism and EGVB in Pingxiang Hospital Affiliated to Southern Medical University from July 2008 to February 2018 were assigned into ET group（78 cases） and ET+PSE group（80 cases） according to the random number table method.The ET group accepted basic treatment and endoscopic treatment，and the ET+PSE group accepted basic treatment，endoscopic treatment and PSE treatment.Ratio of varicose veins disappearance and recurrence and rebleeding were compared between the two groups.White blood cell count，platelet count，liver fibrosis index〔hyaluronic acid（HA），type Ⅲ procollagen peptide（PⅢP），laminin（LN） and type Ⅳ collagen（Ⅳ-C）〕，portal vein diameter，portal vein blood flow velocity，portal venous flow，splenic vein diameter，splenic vein blood flow velocity，splenic venous flow at three time points（before the treatment，four weeks and 12 weeks after the treatment） and incidence of complications in the two groups were analyzed.Results　There was no significant difference between the mortality of patients in two groups（P=1.000）．The ratio of varicose veins disappearance in ET+PSE group was higher than that in ET group，while ratios of varicose veins recurrence and rebleeding in ET+PSE group were significantly lower than those in the ET group at three and six months after the operation（P<0.05）．There were interactions between the treatment and time in white blood cell count，platelet count，HA，PⅢP，LN and Ⅳ-C and its main effects were significant（P<0.001）．The white blood cell count and platelet count in the ET+PSE group at four and 12 weeks after the operation were significantly higher than those at the preoperative time point in the same group and those at the simultaneous time point in the ET group，while HA，PⅢP，LN and Ⅳ-C were significantly lower than those at the preoperative time point in the same group and those at the simultaneous time point in the ET groups（P<0.05）．There were interactions between the treatment and time in portal vein diameter，portal vein blood flow velocity，portal venous flow，splenic vein diameter，splenic vein blood flow velocity and splenic venous flow and its main effects were significant（P<0.001）．The portal and splenic vein diameters in the ET+PSE group were significantly lower than those at the preoperative time point in the same group and those at the simultaneous time point in the ET group at 12 weeks after the operation.The portal vein blood flow velocity，portal venous flow，splenic vein blood flow velocity and splenic venous flow in the ET+PSE group at four and 12 weeks after the operation were significantly higher than those at the preoperative time point in the same group and those at the simultaneous time point in the ET group（P<0.05）．There was no significant difference between the incidences of chest pain in the two groups（P>0.05）．The incidences of fever，abdominal pain and ascites in the ET+PSE group were significantly higher than those in the ET group（P<0.05）．Conclusion　ET can effectively treat the patients with hepatic cirrhosis combined with hypersplenism and EGVB，and PSE can further improve the curative effect.

Key words: Liver cirrhosis, Hypersplenism, Esophageal and gastric varices, Natural orifice endoscopic surgery, Splenic artery embolization, Hemorrhage

摘要： 背景　肝硬化合并脾功能亢进和食管胃底静脉曲张出血（EGVB）患者，由于白细胞和血小板减少、凝血因子减少、凝血功能障碍、出血量大、再出血发生率高，经内镜及药物紧急治疗急性出血后，需进一步采用部分脾动脉栓塞术（PSE）治疗脾功能亢进。目的　评价内镜治疗（ET）联合PSE治疗肝硬化合并脾功能亢进和EGVB的效果。方法　选取2008年7月—2018年2月南方医科大学附属萍乡医院收治的肝硬化合并脾功能亢进和EGVB住院患者158例，根据随机数字表法将其分为ET组（78例）和ET+PSE组（80例）。ET组给予基本治疗和内镜处理，ET+PSE组给予基本治疗、内镜处理和PSE治疗。比较两组静脉曲张消失率、静脉曲张复发率及再出血率；于术前、术后4、12周检测白细胞计数、血小板计数、肝纤维化指标〔透明质酸（HA）、Ⅲ型前胶原肽（PⅢP）、层黏蛋白（LN）和Ⅳ型胶原（Ⅳ-C）〕以及门静脉直径、血流速度、血流量和脾静脉直径、血流速度、血流量；并观察并发症发生率。结果　ET组和ET+PSE组病死率比较，差异无统计学意义（P=1.000）；ET+PSE组静脉曲张消失率高于ET组，静脉曲张复发率、3个月再出血率、6个月再出血率均低于ET组（P<0.05）。治疗方法和时间对白细胞计数、血小板计数、HA、PⅢP、LN和Ⅳ-C均存在交互作用（P<0.001）；治疗方法和时间对白细胞计数、血小板计数、HA、PⅢP、LN和Ⅳ-C主效应均显著（P<0.001）。其中ET+PSE组术后4、12周白细胞计数和血小板计数均高于术前和同时间点ET组，HA、PⅢP、LN和Ⅳ-C均低于术前和同时间点ET组（P<0.05）。治疗方法和时间对门静脉直径、血流速度、血流量和脾静脉直径、血流速度、血流量均存在交互作用（P<0.001）；治疗方法和时间对门静脉直径、血流速度、血流量和脾静脉直径、血流速度、血流量主效应均显著（P<0.001）。其中ET+PSE组术后12周门静脉直径、脾静脉直径均低于术前和同时间点ET组；ET+PSE组术后4、12周门静脉血流速度和血流量、脾静脉血流速度和血流量均低于术前和同时间点ET组（P<0.05）。两组胸痛发生率比较，差异无统计学意义（P>0.05）。ET+PSE组发热、腹痛、腹腔积液发生率均高于ET组（P<0.05）。结论　ET能有效治疗肝硬化合并脾功能亢进和EGVB，PSE能进一步提高疗效。

关键词: 肝硬化, 脾功能亢进, 食管和胃静脉曲张, 自然腔道内镜手术, 脾动脉栓塞, 出血