The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration
The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration
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DOI：
10.1007/s00535-007-2077-1
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发表时间：
2007-08-01
影响因子：
6.3
通讯作者：
Chayama, Kazuaki
中科院分区：
文献类型：
--
作者：
Hiraga, Nobuhiko;Aikata, Hiroshi;Chayama, Kazuaki
背景本研究的目的是评价胃底静脉曲张出血患者行球囊闭塞逆行经静脉闭塞术（B-RTO）的长期结局和并发症。方法. 1994年12月至2005年9月期间，34例接受B-RTO治疗的胃静脉曲张出血连续患者入组本研究（急诊病例，n = 12;择期病例，n = 22）。对远期结果、并发症和各种肝功能进行了评价。结果34例急性出血事件患者中有31例（91%）实现了完全闭塞。在剩下的患者中，有一个技术故障，其他两个只有部分闭塞。2例部分闭塞患者未实现止血。止血率为94%（31/33）。治疗期间所有完全闭塞的患者胃静脉曲张均消失。胃底静脉曲张根除率为91%。3例患者发生食管静脉曲张再出血。再出血率为10%（3/31）。完全闭塞后未观察到胃静脉曲张再出血。无患者显示Child-Pugh评分恶化。虽然食管静脉曲张的5年累积恶化率为52%，但未观察到门脉高压性胃病或异位静脉曲张。食管静脉曲张恶化的患者通过内镜手术成功治疗。5年生存率为68%。结论. B-RTO可用于治疗胃底静脉曲张出血，达到胃底静脉曲张根除率高，再出血率低，预后良好，肝功能改善。
Background. The purpose of our study was to evaluate the long-term outcome and complications of balloon-occluded retrograde transvenous obliteration (B-RTO) in patients with hemorrhage from gastric fundal varices. Methods. Thirty-four consecutive patients with bleeding from gastric varices who were treated with B-RTO were enrolled in this study between December 1994 and September 2005 (urgent cases, n = 12; elective cases, n = 22). The long-term outcome, complications, and various liver functions were evaluated. Results. Complete obliteration was achieved in 31 of 34 (91%) patients with an acute bleeding episode. In one of the remaining patients, there was a technical failure, and the other two had only partial obliteration. The two patients with partial obliteration did not obtain hemostasis. Thus, the rate of hemostasis was 94% (31/33). Gastric varices disappeared in all patients with complete obliteration during the treatment. The rate of gastric variceal eradication was 91%. Variceal rebleeding from esophageal varices occurred in three patients. The rate of rebleeding was 10% (3/31). Rebleeding from gastric varices was not observed after complete obliteration. None of the patients showed worsening of their Child-Pugh score. Although the 5-year cumulative worsening rate of esophageal varices was 52%, neither portal hypertensive gastropathy nor ectopic varices were observed. The patients with worsening esophageal varices were successfully treated with an endoscopic procedure. The 5-year survival rate was 68%. Conclusions. B-RTO is useful for treatment of bleeding gastric varices, achieving high eradication of gastric varices, a low rebleeding rate, and a fairly good prognosis with improved hepatic function.