Management of gastric fundal varices without gastro-renal shunt in 15 patients
Management of gastric fundal varices without gastro-renal shunt in 15 patients
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DOI：
10.3748/wjg.14.448
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发表时间：
2008-01-21
影响因子：
4.3
通讯作者：
Arakawa, Tetsuo
中科院分区：
文献类型：
--
作者：
Kameda, Natsuhiko;Higuchi, Kazuhide;Arakawa, Tetsuo
目的：检测不伴胃肾分流(GRS)的胃底静脉曲张(GV)的门脉血流动力学，并回顾性探讨各种治疗方法对根除的效果。方法：选取我院收治的94例GV高危肝硬化患者纳入研究。我们回顾性检查了他们的特征、肝功能和门静脉血流动力学。我们首先进行了球囊闭塞逆行经静脉闭塞术（BRTO）。如果技术上无法进行 BRTO，则进行内镜注射硬化治疗（x-氰基丙烯酸酯胶（CA））或经皮肝穿刺闭塞术（PTO）。 结果：94 例患者中，79 例（84.0%）存在 GRS，其余 15 例（16.0%）不存在。膈下静脉与下腔静脉相连，作为引流静脉。 15例无GRS的患者中，有13例（86.7%）进行了BRTO，其中4例患者进行了BRTO，5例患者进行了PTO，每次手术的根除率均为100%，但BRTO、CA和PTO的6个月内早期复发率分别为16.7%、50.0%和40.0%。无论是否存在 GRS，如果血流动力学检查显示引流静脉直接连接到没有 GRS 的 GV，则 BRTO 可能是治疗 GV 的有效方法 (c) 2008 WJG 保留所有权利。
AIM: To examine the portal hemodynamics of gastric fundal varices (GV) without gastro-renal shunt (GRS), and to retrospectively investigate the effects of various kinds of treatment on eradication.METHODS: Ninety-four liver cirrhosis patients at high-risk of GV were treated in our hospital and enrolled in this study. We retrospectively examined their characteristics, liver function, and portal hemodynamics of GV. We performed balloon-occluded retrograde transvenous obliteration (BRTO) at first. If it was not technically possible to perform BRTO, endoscopic injection sclerotherapy using (x-cyanoacrylate glue (CA) or percutaneous transhepatic obliteration (PTO) was performed.RESULTS: Among the 94 patients, a GRS was present, in 79 (84.0%), and absent in the remaining 15 (16.0%). The subphrenic vein was connected to the inferior vena cava as the drainage vein in 13 (86.7%) out of the 15 cases without GRS. We performed BRTO in 6 patients CA in 4 patients and PTO in 5 patients. The eradication rate was 100% for each procedure, but the rate of early recurrence within 6 mo was 16.7% for BRTO, 50.0% for CA and 40.0% for PTO, respectively.CONCLUSION: We should examine the hemodynamics; before treatment of GV irrespective of the existence of GRS. If this hemodynamic examination reveals that the drainage vein connects directly to the inferior vena cava in GV without GRS, BRTO may be an effective treatment for GV with GRS. (c) 2008 WJG. All rights reserved.