Macedo Thanila A, Andrews James C, Kamath Patrick S
Department of Radiology, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA.
Cardiovasc Intervent Radiol. 2005 Mar-Apr;28(2):178-84. doi: 10.1007/s00270-004-0148-8.
To evaluate the results of percutaneous management of ectopic varices, a retrospective review was carried out of 14 patients (9 men, 5 women; mean age 58 years) who between 1992 and 2001 underwent interventional radiological techniques for management of bleeding ectopic varices. A history of prior abdominal surgery was present in 12 of 14 patients. The interval between the surgery and percutaneous intervention ranged from 2 to 38 years. Transhepatic portal venography confirmed ectopic varices to be the source of portal hypertension-related gastrointestinal bleeding. Embolization of the ectopic varices was performed by a transhepatic approach with coil embolization of the veins draining into the ectopic varices. Transjugular intrahepatic portosystemic shunt (TIPS) was performed in the standard fashion. Eighteen procedures (12 primary coil embolizations, 1 primary TIPS, 2 re-embolizations, 3 secondary TIPS) were performed in 13 patients. One patient was not a candidate for percutaneous treatment. All interventions but one (re-embolization) were technically successful. In 2 of 18 interventions, re-bleeding occurred within 72 hr (both embolization patients). Recurrent bleeding (23 days to 27 months after initial intervention) was identified in 9 procedures (8 coil embolizations, 1 TIPS due to biliary fistula). One patient had TIPS revision because of ultrasound surveillance findings. New encephalopathy developed in 2 of 4 TIPS patients. Percutaneous coil embolization is a simple and safe treatment for bleeding ectopic varices; however, recurrent bleeding is frequent and reintervention often required. TIPS can offer good control of bleeding at the expense of a more complex procedure and associated risk of encephalopathy.
为评估经皮治疗异位静脉曲张的效果，我们对1992年至2001年间接受介入放射技术治疗出血性异位静脉曲张的14例患者（9例男性，5例女性；平均年龄58岁）进行了回顾性研究。14例患者中有12例有腹部手术史。手术与经皮介入之间的间隔时间为2至38年。经肝门静脉造影证实异位静脉曲张是门静脉高压相关胃肠道出血的来源。采用经肝途径对流入异位静脉曲张的静脉进行弹簧圈栓塞，以栓塞异位静脉曲张。经颈静脉肝内门体分流术（TIPS）按标准方式进行。13例患者共进行了18次操作（12次初次弹簧圈栓塞、1次初次TIPS、2次再次栓塞、3次二次TIPS）。1例患者不适合经皮治疗。除1次（再次栓塞）外，所有干预操作在技术上均获成功。在18次干预中有2次，患者在72小时内再次出血（均为栓塞患者）。9次操作（8次弹簧圈栓塞、1次因胆瘘行TIPS）出现复发性出血（初次干预后23天至27个月）。1例患者因超声监测结果进行了TIPS修正。4例TIPS患者中有2例出现了新的肝性脑病。经皮弹簧圈栓塞是治疗出血性异位静脉曲张的一种简单且安全的方法；然而，复发性出血很常见，且常常需要再次干预。TIPS能很好地控制出血，但操作更为复杂，且有发生肝性脑病的相关风险。
