Choi Young Ho, Yoon Chang Jin, Park Jae Hyung, Chung Jin Wook, Kwon Jong Won, Choi Guk Myung
Department of Radiology, Seoul City Boramae Hospital, Seoul, Korea.
Korean J Radiol. 2003 Apr-Jun;4(2):109-16. doi: 10.3348/kjr.2003.4.2.109.
To assess the feasibility of balloon-occluded retrograde transvenous obliteration (BRTO) in active gastric variceal bleeding, and to compare the findings with those of transjugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHDOS: Twenty-one patients with active gastric variceal bleeding due to liver cirrhosis were referred for radiological intervention. In 15 patients, contrast-enhanced CT scans demonstrated gastrorenal shunt, and the remaining six (Group 1) underwent TIPS. Seven of the 15 with gastrorenal shunt (Group 2) were also treated with TIPS, and the other eight (Group 3) underwent BRTO. All patients were followed up for 6 to 21 (mean, 14.4) months. For statistical inter-group comparison of immediate hemostasis, rebleeding and encephalopathy, Fisher's exact test was used. Changes in the Child-Pugh score before and after each procedure in each group were statistically analyzed by means of Wilcoxon's signed rank test.
One patient in Group 1 died of sepsis, acute respiratory distress syndrome, and persistent bleeding three days after TIPS, while the remaining 20 survived the procedure with immediate hemostasis. Hepatic encephalopathy developed in four patients (one in Group 1, three in Group 2, and none in Group 3); one, in Group 2, died while in an hepatic coma 19 months after TIPS. Rebleeding occurred in one patient, also in Group 2. Except for transient fever in two Group-3 patients, no procedure-related complication occurred. In terms of immediate hemostasis, rebleeding and encephalopathy, there were no statistically significant differences between the groups (p > 0.05). In Group 3, the Child-Pugh score showed a significant decrease after the procedure (p = 0.02).
BRTO can effectively control active gastric variceal bleeding, and because of immediate hemostasis, the absence of rebleeding, and improved liver function, is a good alternative to TIPS in patients in whom such bleeding, accompanied by gastrorenal shunt, occurs.
评估球囊闭塞逆行静脉栓塞术（BRTO）治疗活动性胃静脉曲张出血的可行性，并将结果与经颈静脉肝内门体分流术（TIPS）进行比较。材料与方法：21例因肝硬化导致活动性胃静脉曲张出血的患者接受了放射介入治疗。15例患者经增强CT扫描显示存在胃肾分流，其余6例（第1组）接受了TIPS。15例有胃肾分流的患者中，7例（第2组）也接受了TIPS治疗，另外8例（第3组）接受了BRTO。所有患者均随访6至21个月（平均14.4个月）。采用Fisher精确检验对即时止血、再出血和肝性脑病进行组间统计学比较。采用Wilcoxon符号秩检验对每组每次手术后Child-Pugh评分的变化进行统计学分析。
第1组1例患者在TIPS术后3天死于败血症、急性呼吸窘迫综合征和持续出血，其余20例患者手术成功并即时止血。4例患者发生肝性脑病（第1组1例，第2组3例，第3组无）；第2组1例患者在TIPS术后19个月死于肝昏迷。第2组1例患者发生再出血。除第3组2例患者出现短暂发热外，未发生与手术相关的并发症。在即时止血、再出血和肝性脑病方面，各组之间无统计学显著差异（p>0.05）。第3组术后Child-Pugh评分显著降低（p=0.02）。
BRTO可有效控制活动性胃静脉曲张出血，且因其即时止血、无再出血及肝功能改善，对于发生此类出血并伴有胃肾分流的患者而言，是TIPS的良好替代方案。
