Balloon-occluded retrograde transvenous obliteration improves liver function in patients with cirrhosis and portal hypertension
Balloon-occluded retrograde transvenous obliteration improves liver function in patients with cirrhosis and portal hypertension
复制标题
DOI：
10.1046/j.1440-1746.2003.03087.x
复制
发表时间：
2003-08-01
影响因子：
4.1
通讯作者：
Sata, M
中科院分区：
文献类型：
--
作者：
Miyamoto, Y;Oho, K;Sata, M
背景与目的：球囊闭塞逆行经静脉闭塞术（B-RTO）是一种治疗伴有自发性脾肾分流（SRS）的胃底大静脉曲张的新型治疗方法。然而，B-RTO对肝功能的影响仍不清楚。方法：研究了14例接受SRS治疗的门脉高压和胃静脉曲张患者，其中4例为急性出血患者，5例为高危静脉曲张患者，5例为难治性门体性脑病患者。采用连续吲哚菁绿（ICG）输注方法进行肝静脉插管以评估肝血流量和肝功能。为了评估肝细胞的代谢活性，计算了 ICG 的内在清除率。在所有患者中，在 B-RTO 之前、之后 1 周和 1 个月进行内窥镜检查，此后每 6 个月随访一次。基线测量后，进行 B-RTO。 B-RTO 后四周，重复相同的导管测量。结果：B-RTO 在所有患者中均成功。对比增强计算机断层扫描显示在后续测量之前 SRS 完全消失。所有患者在 B-RTO 后 6 个月内镜下根除胃底静脉曲张，B-RTO 后 1 周内脑病得到改善。 B-RTO 后，肝血流量（441 +/- 214 vs 668 +/- 299 mL/min，P < 0.0001）和 ICG 内在清除率（233 +/- 123 vs 285 +/- 148 mL/min，P < 0.05）显着增加。此外，B-RTO治疗后肝内阻力下降（P < 0.005）。结论：从短期评估来看，B-RTO增加了门脉高压患者的肝脏血流量，改善了肝脏的代谢活动。 (C) 2003 年布莱克威尔出版亚洲有限公司。
Background and Aim: Balloon-occluded retrograde transvenous obliteration (B-RTO) is a novel therapeutic method for the treatment of large gastric fundal varices with spontaneous splenorenal shunt (SRS). However, the effects of B-RTO on liver function remain unknown.Methods: Fourteen patients with portal hypertension and gastric varices with SRS were studied, consisting of four patients with acute bleeding, five with high-risk varices, and five with refractory portosystemic encephalopathy. Hepatic venous catheterization was performed to evaluate hepatic blood flow and liver function using the continuous indocyanine green (ICG) infusion method. To assess the metabolic activity of the hepatocyte, the intrinsic clearance of ICG was calculated. In all patients, endoscopic study was performed before and 1 week and 1 month after the B-RTO, and followed every 6 months thereafter. After baseline measurements, B-RTO was performed. Four weeks after the B-RTO, the same catheter measurements were repeated.Results: The B-RTO was successful in all patients. Contrast-enhanced computed tomography showed complete obliteration of the SRS prior to the follow-up measurements. Endoscopic eradication of the fundal varices was obtained 6 months after B-RTO in all patients and encephalopathy was improved within 1 week after B-RTO. Following the B-RTO, hepatic blood flow (441 +/- 214 vs 668 +/- 299 mL/min, P < 0.0001) and the intrinsic clearance of ICG (233 +/- 123 vs 285 +/- 148 mL/min, P < 0.05) were significantly increased. Furthermore, intrahepatic resistance decreased after the B-RTO (P < 0.005).Conclusion: From short-term assessment, B-RTO increases hepatic blood flow and improves the metabolic activity of the liver in patients with portal hypertension. (C) 2003 Blackwell Publishing Asia Pty Ltd.