经皮经肝食管胃底静脉曲张栓塞术的临床应用

目的评价经皮经肝食管胃底静脉曲张栓塞术的临床应用价值。方法肝硬化门静脉高压合并食管胃底静脉曲张破裂出血患者30例(24例为食管静脉套扎及硬化治疗术后再次出血；6例为消化道出血未行内镜治疗者)。电视透视下取右腋中线或剑突下方穿刺进入门静脉分支。用弹簧钢圈、无水乙醇和明胶海绵栓塞食管胃底静脉。2例栓塞后门静脉内留置导管-药盒系统行区域性药物灌注治疗。结果30例患者胃冠状静脉超选择插管、栓塞全部成功。胃短静脉超选择插管栓塞成功率90％。27例患者术后得到随访，随访2～18个月。17例患者术后胃镜复查显示胃底曲张静脉完全消失者13例，明显改善者4例。2例于栓塞术后1周、2个月再出血，再次栓塞后无再出血。2例门静脉留置药盒行区域性中西药物灌注者治疗后门静脉压力分别下降10cmH2O(1cmH2O=0．098kPa)和8cmH2O。结论经皮经肝食管胃底静脉曲张栓塞术创伤小、止血效果肯定，在急诊止血方面更具优势，应该成为门静脉高压食管胃底静脉曲张破裂出血的常规治疗方法之一。经留置药盒行门静脉区域性中西药物灌注治疗肝硬化值得进一步探讨。     

经皮经肝TH胶定位栓塞治疗食管胃底静脉曲张出血的护理

我院消化科自2003年2月-2004年10月开展了经皮经肝TH胶定位栓塞于冠状静脉主干及胃底和贲门的交通支，治疗食管胃底静脉曲张出血取得了较好的中远期效果，现将护理要点报告如下。     

经皮经肝TH胶"三明治"栓塞术治疗食管胃底静脉曲张

目的:介绍经皮经肝TH胶“三明治”栓塞技术在胃冠状静脉栓塞术中的应用。方法:采用经皮经肝TH胶“三明治”定位栓塞胃冠状静脉(必要时联合栓塞胃短和胃后静脉)治疗食管胃底静脉曲张病人43例。27例病人同时行部分脾动脉栓塞;另9例既往己行脾切除 断流术后,仅行TH胶定位栓塞;9例为急症栓塞治疗。结果:①33例成功,成功率92%;②近期效果:术后即刻食管胃底曲张静脉血流消失100%;术后27例复查,食管胃底静脉曲张基本消失16例(59.3%),减轻8例(33.3%),总有效率92.6%;③手术死亡率2.8%,,未发生TH胶异位栓塞;④23例随访3~16个月(平均9.5个月),曲张静脉复发或加重2例(8.7%),再出血1例(4.3%),静脉曲张持续稳定占91.3%。结论:经皮经肝TH胶定位栓塞术操作安全、疗效确切,是食管胃底静脉曲张合理的介入治疗方法。     

经自发性胃-肾静脉和脾-肾静脉分流道栓塞治疗胃底静脉曲张和肝性脑病

经自发性胃－肾静脉和脾－肾静脉分流道栓塞治疗胃底静脉曲张和肝性脑病崔进国周桂芬张书田田慧琴薛春华张丽丽在门静脉高压症患者中，通过侧支循环形成自发性胃－肾静脉分流（ｓｐｏｎｔａ－ｎｅｏｕｓｇａｓｔｒｏ－ｒｅｎａｌｓｈｕｎｔ）和自发性脾－肾静脉分流（ｓｐ...     

经皮经肝食管胃底静脉栓塞术治疗肝硬化静脉曲张的疗效评价

目的评价经皮经肝食管胃底静脉栓塞术(PTO)在治疗肝硬化静脉曲张的应用价值。方法对56例肝硬化合并食管胃底静脉曲张患者施行PTO治疗,其中35例因急性上消化道出血行急症止血治疗,10例为消化道出血停止后择期栓塞,11例肝硬化伴重度食管静脉曲张行预防性PTO治疗。结果56例患者食管胃底曲张静脉插管、栓塞成功率达100%。35例急性上消化道出血患者,急症栓塞术后均止血成功;11例行预防性PTO治疗病例,术后复查食管静脉曲张7例接近正常,4例静脉曲张程度由重度降为轻度。47例接受2～60个月随访,再出血5例,死亡4例,原因分别为再发消化道出血(1例),肝功能衰竭(1例),合并肝癌(2例)。结论对于肝硬化食管胃底静脉曲张患者,PTD是一种安全、有效的治疗方法,值得推广应用。     

经皮肝穿刺食管胃底静脉介入栓塞技术的探讨

目的探讨经皮肝穿刺食管胃底静脉栓塞治疗和预防肝硬化、门静脉高压食管胃底静脉曲张破裂出血的介入栓塞技术的临床应用。方法对48例肝硬化门静脉高压食管胃底静脉曲张患者,采用经皮肝穿刺食管胃底静脉栓塞或联合脾动脉部分栓塞术预防和控制上消化道出血。结果经皮肝穿刺食管胃底静脉栓塞手术成功率97.9%,止血率达100%。术中弹簧圈移位1例,发生以血压下降、心率减慢为特点的迷走反射4例;术后出现顽固性(胸)腹水4例,腹腔内出血导致死亡1例。术后连续随访1年:在前6个月内2例死于肝衰竭,再出血2例;在后6个月内3例失访,再出血5例。结论经皮肝穿刺食管胃底静脉栓塞技术是一种微创、有效的方法。注意手术操作细节对提高手术成功率、降低手术并发症有重要意义。     

经皮经肝门静脉栓塞食管胃底静脉治疗门脉高压性上消化道出血

门脉高压导致胃底食管静脉曲张破裂出血是上消化道出血的常见原因,其出血量大,来势凶猛,常危及生命。对于胃底食管静脉曲张破裂的上消化道出血,目前临床治疗方法较多,内科治疗(药物治疗、三腔管压迫或硬化曲张的静脉等)大多无效(患者容易再次大出血),外科治疗(断流术或各种分流     

Rupture of jejunal varices treated with balloon-occluded retrograde transvenous obliteration

Bleeding from varices arising from outside of the gastroesophageal region is rare. We report a case of ruptured jejunal varices, successfully treated with B-RTO. Our patient was a 60-year-old man with alcoholic cirrhosis who had undergone total gastrectomy two years before he visited our clinic with tarry stool and hypotensive shock. Results of 3DMDCT clearly showed variceal formation at the jejunal loop around the anastomotic site and abdominal wall as well as the extensive epigastric outflow tract, which finally drained into the left femoral vein. B-RTO was carried out via right femoral approach, using a microcatheter system. The varices disappeared, and the patient remained asymptomatic 18 months after the treatment.     

Usefulness of intra-procedural cone-beam computed tomography in modified balloon-occluded retrograde transvenous obliteration of gastric varices

AIM:To evaluate whether intra-procedural conebeam computed tomography(CBCT)performed during modified balloon-occluded retrograde transvenous obliteration(mB RTO)can accurately determine technical success of complete variceal obliteration.METHODS:From June 2012 to December 2014,15 patients who received CBCT during m BRTO for treatment of portal hypertensive gastric variceal bleeding were retrospectively evaluated.Three-dimensional(3D)CBCT images were performed and evaluated prior to the end of the procedure,and these were further analyzed and compared to the pre-procedure contrast-enhanced computed tomography to determine the technical success of m BRTO including:Complete occlusion/obliteration of:(1)gastrorenal shunt(GRS);(2)gastric varices;and(3)afferent feeding veins.Post-mB RTO contrast-enhanced CT was used to confirm the accuracy and diagnostic value of CBCT within 2-3 d.RESULTS:Intra-procedural 3D-CBCT images were 100% accurate in determining the technical success of m BRTO in all 15 cases.CBCT demonstrated complete occlusion/obliteration of GRS,gastric varices,collaterals and afferent feeding veins during m BRTO,which was confirmed with post-m BRTO CT.Two patients showed incomplete obliteration of gastric varices and feeding veins on CBCT,which therefore required additional gelfoam injections to complete the procedure.No patient required additional procedures or other interventions during their follow-up period(684 ± 279 d).CONCLUSION:CBCT during mB RTO appears to accurately and immediately determine the technical success of mB RTO.This may improve the technical and clinical success/outcome of m BRTO and reduce additional procedure time in the future.     

"Downgrading" of gastric varices with multiple collateral veins in balloon-occluded retrograde transvenous obliteration

The efficacy of a "downgrading" method for treatment of gastric varices (GVs) was evaluated in 15 patients who had undergone balloon-occluded retrograde transvenous obliteration (B-RTO) of GVs with multiple collateral veins. Downgrading in this study was meant to transform high-grade GVs into GVs with a low-grade architecture more amenable to treatment. Success was defined as gastrorenal shunt occlusion at the proximal site with a 6-F balloon catheter advanced over a microcatheter and without opacification of large collateral vessels. Thirteen of 15 patients with grade 3/4 GVs had their GVs successfully downgraded. The procedure is thought to be safe and effective in the initial B-RTO procedure.     

Long-term results of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy

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 11 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.