球囊导管闭塞下逆行性静脉栓塞术治疗胃静脉曲张破裂出血患者疗效分析*

doi:10.3969/j.issn.1672-5069.2022.03.026

实用肝脏病杂志 ›› 2022, Vol. 25 ›› Issue (3): 407-410.doi: 10.3969/j.issn.1672-5069.2022.03.026

球囊导管闭塞下逆行性静脉栓塞术治疗胃静脉曲张破裂出血患者疗效分析^*

郭慧雯, 张峰, 肖江强, 张玮, 张明, 邹晓平, 诸葛宇征

210000 南京市南京医科大学附属江宁医院消化科(郭慧雯);南京大学医学院附属鼓楼医院消化科(张峰,肖江强,张玮,张明,邹晓平,诸葛宇征)

收稿日期:2020-03-23 出版日期:2022-05-10 发布日期:2022-05-17
通讯作者: 张峰,E-mail:fzdndx@126.com
作者简介:郭慧雯,女,28岁,硕士研究生。E-mail:1420389818@qq.com
基金资助:
^*国家自然科学基金资助项目(编号:81570550)

Short-term observation of balloon-occluded retrograde transvenous obliteration in the treatment of patients with liver cirrhosis and complicated gastric varices

Guo Huiwen, Zhang Feng, Xiao Jiangqiang, et al

Department of Gastroenterology, Jiangning Hospital, Affiliated to Nanjing Medical University, Nanjing 210008, Jiangsu Province, China

Received:2020-03-23 Online:2022-05-10 Published:2022-05-17

摘要/Abstract

摘要： 目的胃静脉曲张(GV)破裂出血是肝硬化门脉高压性出血的一种少见类型,但其出血风险最高,内镜下治疗不易控制。本研究旨在探讨球囊导管闭塞下逆行性静脉栓塞术(BRTO)治疗GV破裂出血患者的安全性和短期疗效。方法 2018年11月～2020年1月南京鼓楼医院消化科诊治的13例肝硬化并发GV患者,均接受BRTO治疗。随访观察治疗成功率、技术相关并发症和短期生存等。结果本组BRTO技术成功实施12例(92.3%),术后短期内未出现严重的致死性并发症,术后2例(16.7%)经超声检查发现新发门静脉血栓形成,给予低分子肝素抗凝治疗后血栓消失;在短期随访期间,未发生食管胃静脉曲张破裂出血,1例(7.7%)患者死于原发性肝癌导致的肝衰竭;新发轻度腹腔积液1例,1例肝性脑病患者术后血氨下降,临床症状缓解。结论 BRTO是一项安全、有效的介入技术,可有效预防胃静脉曲张破裂出血,值得进一步扩大应用和观察。

关键词: 肝硬化, 胃静脉曲张, 球囊导管闭塞下逆行性静脉栓塞术, 出血, 治疗

Abstract: Objective Gastric varices (GV) bleeding is one of the rare types of gastrointestinal bleeding resulting from portal hypertension in patients with liver cirrhosis (LC), but the risk is the highest. The failed endoscopic treatment is common. The purpose of this study was to investigate the safety and short-term efficacy of balloon-occluded retrograde transvenous obliteration (BRTO) in the treatment of patients with LC and GV bleeding. Methods 13 patients with LC and GV were encountered in Nanjing Drum Tower Hospital between November 2018 and January 2020, and all underwent BRTO. The patients were followed-up and the success rate of BRTO procedure, short-term postoperative complications, variceal bleeding and survival were recorded. Results The technical success rate was 92.3%, and there was no serious or fatal complications in our series during two month follow-up period after BRTO; two patients (16.7%) showed new portal vein thrombosis discovered by color Doppler ultrasonography after BRTO, and they disappeared after anticoagulation therapy with low molecular weight heparin; none of the patients suffered from esophageal or gastric variceal bleeding, and one patient died of hepatic failure owing to primary liver cancer; one patient had mild ascites, and one patient with hepatic encephalopathy before BRTO had an obvious decrease of blood ammonia level and remission of clinical symptoms. Conclusion BRTO might be a safe and effective interventional technique, which could prevent gastric variceal bleeding and warrants further investigation.

Key words: Liver cirrhosis, Gastric varices, Balloon-occluded retrograde transvenous obliteration, Bleeding, Therapy

郭慧雯, 张峰, 肖江强, 张玮, 张明, 邹晓平, 诸葛宇征. 球囊导管闭塞下逆行性静脉栓塞术治疗胃静脉曲张破裂出血患者疗效分析^*[J]. 实用肝脏病杂志, 2022, 25(3): 407-410.

Guo Huiwen, Zhang Feng, Xiao Jiangqiang, et al. Short-term observation of balloon-occluded retrograde transvenous obliteration in the treatment of patients with liver cirrhosis and complicated gastric varices[J]. Journal of Practical Hepatology, 2022, 25(3): 407-410.

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球囊导管闭塞下逆行性静脉栓塞术治疗胃静脉曲张破裂出血患者疗效分析^*

Short-term observation of balloon-occluded retrograde transvenous obliteration in the treatment of patients with liver cirrhosis and complicated gastric varices

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