球囊辅助下经皮经肝曲张静脉组织胶栓塞治疗孤立胃底静脉曲张  

Balloon-assisted percutaneous transhepatic variceal embolization with cyanoacrylate for treatment of isolated gastric varices

作　　者：王广川[1] 黄广军 陈功海 胡锦华[1] 史永军[1] 张春清[1] Wang Guangchuan;Huang Guangjun;Chen Gonghai;Shi Yongjun;Zhang Chunqing(Department of Gastroenterology,Shandong Provincial Hospital Affiliated to Shandong University,Jinan 250021,China)

机构地区：[1]山东大学附属省立医院消化内科

出　　处：《中华消化病与影像杂志（电子版）》2019年第2期55-60,共6页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

基　　金：山东省重点研发项目(2015GSF118012);山东省重点研发项目(2018GSF118100);济南市临床医学科技创新计划(201805069)

摘　　要：目的,评估球囊辅助下经皮经肝曲张血管组织胶栓塞术治疗合并胃肾分流的孤立胃底静脉曲张的疗效及安全性。方法,选取2010年3月至2015年6月,存在合并胃肾分流的孤立胃底静脉曲张,在山东大学附属省立医院消化内科住院,并在经肾静脉行分流道球囊闭塞后,行经皮经肝曲张血管组织胶栓塞术的30例患者纳入回顾性分析,总结技术成功率、临床成功率、并发症发生情况以及随访情况。结果,30例患者均成功行组织胶栓塞术,技术成功率为100%(30/30)。除1例发生无症状的肺栓塞外,未见其他严重并发症。平均随访30个月,再出血发生率为4/30(13.3%),食管静脉曲张加重发生率为4/30(13.3%),新发腹水或腹水加重发生率为3/30(10%)。术后1、2、3、5年的累计生存率分别为96.3%、96.3%、79.9%、79.9%。结论,球囊辅助下经皮经肝曲张血管组织胶栓塞术治疗合并胃肾分流的孤立胃底静脉曲张安全可行,疗效可靠,是该类曲张出血的有用替代方案。Objective To evaluate the effectiveness and safety of percutaneous transhepatic variceal embolization(PTVE)with cyanoacrylate assisted with balloon for the treatment of isolated gastric varice(IGV)with gastrorenal shunt(GRS). Methods Thirty patients with IGV associated with GRS who underwent balloon-assisted PTVE after shunt balloon occlusion via renal vein in Department of Gastroenterology of Shandong Provincial Hospital Affiliated to Shandong University between March 2010 and June 2015 were retrospectively analyzed.The technical success rate,clinical success rate,complications and follow-up were summarized. Results Balloon-assisted PTVE was technically successful in all 30 patients.No serious complications were observed except for one nonsymptomatic pulmonary embolism.During a mean follow-up of 30 months,re-bleeding was observed in 4/30(13.3%)patients,worsening of esophageal varices was observed in 4/30(13.3%)patients,and newly developed or aggravated ascites were observed in 3/30(10%)patients.The 1-,2-,3-and 5-year cumulative survival rates were 96.3%,96.3%,79.9% and 79.9%,respectively. Conclusion Balloon-assisted PTVE with cyanoacrylate is technically feasible,safe and effective for the treatment of IGV associated with GRS,and it is an useful alternative scheme.

关 键 词：门静脉高压 孤立胃底静脉曲张 胃肾分流 经皮经肝曲张血管栓塞术 

分 类 号：R575.2[医药卫生—消化系统]