Obideen M Kamil, Wehbi Mohammad, Ghazale Amaar, Martinez Enrique, Cai Qiang
Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA 30322, USA.
J Clin Gastroenterol. 2004 Apr;38(4):373-6. doi: 10.1097/00004836-200404000-00014.
Although esophageal varices are the most common site of variceal bleeding, extraesophageal varices cause up to 30% of variceal bleeding. Unlike esophageal variceal bleeding, the experience in management of extraesophageal variceal bleeding, especially nongastric extraesophageal variceal bleeding is limited, and there are no established guidelines for treatment of nongastric extraesophageal variceal bleeding. This study aims to provide experience in treatment of nongastric extraesophageal variceal bleeding with transjugular intrahepatic portosystemic shunt in a tertiary medical center.
We retrospectively reviewed all cases, admitted or transferred to Emory University Hospital, with extraesophageal variceal bleeding who had transjugular intrahepatic portosystemic shunt as the final resolution to control bleeding over a period of 4 years, from January 1999 to January 2003. We also compared the outcomes after transjugular intrahepatic portosystemic shunt for bleeding from gastric varices and nongastric extraesophageal varices.
Forty-one patients (33 gastric varices and 8 nongastric extraesophageal varices) with extraesophageal variceal bleeding who had transjugular intrahepatic portosystemic shunt performed were identified in this study period. Bleeding was controlled immediately in 90% (37/41) of those patients. The mortality was 7% (3/41). The rebleeding rate was 10% (4/41). Encephalopathy occurred in 24% (10/41) of the patients. Patients with gastric varices bleeding appeared to have more advanced liver disease than patients with nongastric extraesophageal varices bleeding. The outcomes after transjugular intrahepatic portosystemic shunt for bleeding from gastric varices and nongastric extraesophageal varices were similar.
Transjugular intrahepatic portosystemic shunt is an effective and safe treatment of extraesophageal variceal bleeding, including bleeding from gastric varices and nongastric extraesophageal varices.
尽管食管静脉曲张是静脉曲张出血最常见的部位，但食管外静脉曲张导致的静脉曲张出血占比高达30%。与食管静脉曲张出血不同，食管外静脉曲张出血（尤其是非胃性食管外静脉曲张出血）的治疗经验有限，且尚无针对非胃性食管外静脉曲张出血的既定治疗指南。本研究旨在提供在三级医疗中心采用经颈静脉肝内门体分流术治疗非胃性食管外静脉曲张出血的经验。
我们回顾性分析了1999年1月至2003年1月这4年间，所有入住或转至埃默里大学医院、因食管外静脉曲张出血而行经颈静脉肝内门体分流术作为最终止血措施的病例。我们还比较了经颈静脉肝内门体分流术治疗胃静脉曲张出血和非胃性食管外静脉曲张出血后的结果。
在本研究期间，共确定了41例因食管外静脉曲张出血而行经颈静脉肝内门体分流术的患者（33例胃静脉曲张和8例非胃性食管外静脉曲张）。这些患者中90%（37/41）的出血得到立即控制。死亡率为7%（3/41）。再出血率为10%（4/41）。24%（10/41）的患者发生了肝性脑病。胃静脉曲张出血的患者似乎比非胃性食管外静脉曲张出血的患者肝病更严重。经颈静脉肝内门体分流术治疗胃静脉曲张出血和非胃性食管外静脉曲张出血后的结果相似。
经颈静脉肝内门体分流术是治疗食管外静脉曲张出血（包括胃静脉曲张出血和非胃性食管外静脉曲张出血）的一种有效且安全的方法。
