Long-term results of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy
Long-term results of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy
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DOI：
10.1016/s1051-0443(07)61912-5
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发表时间：
2001-03-01
影响因子：
2.9
通讯作者：
Sugimura, K
中科院分区：
文献类型：
--
作者：
Fukuda, T;Hirota, S;Sugimura, K
目得：为了评估长期的结果，球囊闭塞逆行经静脉闭塞术（B-RTO）治疗胃静脉曲张（GV）和肝性脑病。材料和方法：共43例谁经历了B-RTO进行了评价，32 GV，两个肝性脑病，和9两者兼而有之。除1例外，所有患者均接受了1年以上（3-60个月，平均30.44个月）的胃肠道内镜连续随访。胃静脉曲张的侧支静脉采用球囊闭塞逆行左肾上腺静脉造影进行分级。分析B-RTO后食管静脉曲张（EV）恶化和Child-Pugh评分改善与侧支静脉发育程度的关系。结果：所有患者GV消失或明显缩小，肝性脑病均完全治愈。21例患者（50.0%）在B-RTO后6个月观察到Child-Pugh评分改善，但仅II型患者（25.6%）在B-RTO后1年观察到改善。8例患者EV恶化，与侧支静脉恶化有关。B-RTO后1年和3年的累积无复发生存率分别为90.8%和87.4%。结论：B-RTO是治疗GV合并肝性脑病安全有效的方法。最重要的预后因素是Child-Pugh分级的程度。
PURPOSE: To evaluate the long-term results of balloon-occluded retrograde transvenous obliteration (B-RTO) for the treatment of gastric varices (GV) and hepatic encephalopathy.MATERIALS AND METHODS: A total of 43 patients who had undergone B-RTO were evaluated, 32 with GV, two with hepatic encephalopathy, and nine with both. All but one had been consecutively followed up with gastrointestinal endoscopy for more than 1 year (3-60 months; mean, 30.44 months). Collateral veins of gastric varices were graded using balloon-occluded retrograde left adrenal venography. The relation of both worsening of esophageal varices (EV) and improved Child-Pugh score after B-RTO to the grades of collateral vein development was analyzed. The relapse-free survival and the prognostic factors for survival after B-RTO were also assessed.RESULTS: GV disappeared or decreased markedly in size, and hepatic encephalopathy was completely cured in all patients. Improvement in Child-Pugh score was observed in 21 patient (50.0%) 6 months after B-RTO, but in only II patients (25.6%) 1 year after B-RTO. Worsening of EV was seen in eight patients and was related to a worsened grade of collateral veins. Cumulative relapse-free survival rate was 90.8% at 1 year and 87.4% at 3 years after B-RTO. The most significant prognostic factor was Child-Pugh classification (relative risk: 4.16).CONCLUSION: B-RTO is a safe and effective treatment for patients with GV and hepatic encephalopathy. The most important prognostic factors are the extent of Child-Pugh classification.