Percutaneous Transportal Sclerotherapy with N-Butyl-2-Cyanoacrylate for Gastric Varices: Technique and Clinical Efficacy
Percutaneous Transportal Sclerotherapy with N-Butyl-2-Cyanoacrylate for Gastric Varices: Technique and Clinical Efficacy
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DOI：
10.3348/kjr.2008.9.6.526
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发表时间：
2008-11-01
影响因子：
4.8
通讯作者：
Han, Young Min
中科院分区：
文献类型：
--
作者：
Kwak, Hyo Sung;Han, Young Min
目的：探讨经皮经门脉硬化治疗胃底静脉曲张的方法和临床疗效。材料与方法：对7例胃底静脉曲张患者采用经皮经门静脉硬化治疗。对于门静脉硬化治疗，门静脉插管是通过经肝途径用6-FR鞘进行的。将5-Fr导管插入胃传入静脉，并将微导管通过5-Fr导管插入静脉曲张。NBCA采用连续单柱注射技术，经微导管注入静脉曲张。术后第二天行CT增强扫描，然后每6个月进行一次。术后1周、3个月、每6个月行胃镜检查。结果：手术技术成功率为88%。在6例患者中，通过微导管注入1-8毫升(平均5.4毫升)的NBCA-碘化油混合物成功地封堵了胃底静脉曲张。没有出现与手术相关的并发症。6个月后的随访内窥镜和CT成像显示，在使用NBCA-碘油混合物和使用微弹簧圈治疗后，任何患者都没有发现胃底静脉曲张。随访期内未见胃底静脉曲张复发。经门静脉硬化治疗后，4例患者出现食道静脉曲张恶化。术后6个月血清白蛋白水平升高，血氨水平下降，凝血酶原时间延长(P<；0.05)。结论：对于不能进行球囊闭塞逆行经静脉封堵术的患者，经皮门脉硬化NBCA治疗可有效阻断胃底静脉曲张。
Objective: This study was deigned to evaluate the technique and clinical efficacy of the use of percutaneous transportal sclerotherapy with N-butyl-2-cyanoacrylate (NBCA) for patients with gastric varices.Materials and Methods: Seven patients were treated by transportal sclerotherapy with the use of NBCA. For transportal sclerotherapy, portal vein catheterization was performed with a 6-Fr sheath by the transhepatic approach. A 5-Fr catheter was introduced into the afferent gastric vein and a microcatheter was advanced through the 5-Fr catheter into the varices. NBCA was injected through the microcatheter in the varices by use of the continuous single-column injection technique. After the procedure, postcontrast computed tomography (CT) was performed on the next day and then every six months. Gastroendoscopy was performed at one week, three months, and then every six months after the procedure.Results: The technical success rate of the procedure was 88%. In six patients, gastric varices were successfully obliterated with 1-8 mL (mean, 5.4 mL) of a NBCA-Lipiodol mixture injected via a microcatheter. No complications related to the procedure were encountered. As seen on the follow-up endoscopy and CT imaging performed after six months, the presence of gastric varcies was not seen in any of the patients after treatment with the NBCA-Lipiodol mixture and the use of microcoils. Recurrence of gastric varices was not observed during the follow-up period. Worsening of esophageal varices occurred in four patients after transportal sclerotherapy. The serum albumin level increased, the ammonia level decreased and the prothrombin time increased at six months after the procedure (P < 0.05).Conclusion: Percutaneous transportal sclerotherapy with NBCA is useful to obliterate gastric varices if it is not possible to perform balloon-occluded retrograde transvenous obliteration.