Matsumoto A, Hamamoto N, Nomura T, Hongou Y, Arisaka Y, Morikawa H, Hirata I, Katsu K
The Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan.
Am J Gastroenterol. 1999 Mar;94(3):643-9. doi: 10.1111/j.1572-0241.1999.00928.x.
Balloon-occluded retrograde transvenous obliteration is an effective new method for treating gastric fundal varices, but subsequent occurrence of esophageal varices creates a problem. The relationship between portal hemodynamics and the occurrence of esophageal varices after prophylactic balloon-occluded retrograde transvenous obliteration was investigated.
Ten cirrhotic patients considered to have high risk gastric fundal varices underwent angiography. Six patients showed a communication between blood flow in gastric wall vessels and that in the gastrorenal shunt (type I), whereas the others (type II) did not. Depending on the flow direction in the left gastric vein, the two groups were further divided into hepatopetal (a) and hepatofugal (b) subgroups. The therapeutic effect on portal hemodynamics and the relationship between pretreatment portal hemodynamics and posttreatment occurrence of esophageal varices were investigated.
Fundal varices disappeared endoscopically in all 10 patients and the gastrorenal shunt was also occluded after the procedure. No patient showed worsening of liver function or systemic complications during follow-up. The increase in portal blood flow was more significant in type Ib patients than in the others. Esophageal varices occurred in all type I patients, and as to those in type Ib, high risk varices developed within 6 months after treatment. On the other hand, esophageal varices did not occur in type II patients.
This procedure was effective for treating gastric fundal varices. However, type Ib patients are likely to develop high risk esophageal varices after occlusion of the gastrorenal shunt.
球囊闭塞逆行静脉栓塞术是治疗胃底静脉曲张的一种有效的新方法，但随后发生的食管静脉曲张却成为一个问题。本研究探讨预防性球囊闭塞逆行静脉栓塞术后门静脉血流动力学与食管静脉曲张发生之间的关系。
10例被认为有高危胃底静脉曲张的肝硬化患者接受了血管造影。6例患者显示胃壁血管血流与胃肾分流血流之间存在交通（I型），而其他患者（II型）则无此情况。根据胃左静脉的血流方向，两组进一步分为向肝型（a）和离肝型（b）亚组。研究了该治疗对门静脉血流动力学的影响以及治疗前门静脉血流动力学与治疗后食管静脉曲张发生之间的关系。
所有10例患者的胃底静脉曲张在内镜下均消失，术后胃肾分流也被闭塞。随访期间无患者出现肝功能恶化或全身并发症。Ib型患者门静脉血流增加比其他患者更显著。所有I型患者均发生食管静脉曲张，对于Ib型患者，高危静脉曲张在治疗后6个月内出现。另一方面，II型患者未发生食管静脉曲张。
该手术治疗胃底静脉曲张有效。然而，Ib型患者在胃肾分流闭塞后可能发生高危食管静脉曲张。
