Taniai Nobuhiko, Yoshida Hiroshi, Mamada Yasuhiro, Tajiri Takashi
First Department of Surgery, Nippon Medical School, Tokyo, Japan.
Hepatogastroenterology. 2005 May-Jun;52(63):949-53.
BACKGROUND/AIMS: Balloon-occluded retrograde transvenous obliteration is an effective method for treating gastric fundal varices. The present retrospective study was performed to determine the clinical efficacy for gastric fundal varices associated with endoscopic therapy, surgery, and interventional radiology including balloon-occluded retrograde transvenous obliteration.
We classified 26 patients to a surgery group, an endoscopic therapy group, and an interventional radiology group according to initial treatment and subsequent treatment, and we compared the rates of hemostasis, eradication, and bleeding in these groups.
Interventional radiology was successful in arresting acute hemorrhage in 100% of cases, while endoscopic therapy was successful in only 50% of cases. The rate of eradication was 100% in the Surgery group, 66.7% in the Endoscopic Therapy group, and 50% in the Interventional Radiology group. The cumulative bleeding rate at 5 years was 0% in the Surgery group, 0% in the Endoscopic therapy group, and 11.1% in the Interventional Radiology group. No significant difference was observed between the three groups.
The treatment-of-choice for gastric fundal variceal hemorrhage is endoscopic injection sclerotherapy and ligation, with interventional radiology as the back-up procedure in case endoscopic injection sclerotherapy and ligation is unsuccessful. Interventional radiology is the treatment-of-choice for elective treatment of gastric fundal varices.
背景/目的：球囊闭塞逆行静脉栓塞术是治疗胃底静脉曲张的有效方法。本回顾性研究旨在确定其与内镜治疗、手术及包括球囊闭塞逆行静脉栓塞术在内的介入放射学联合治疗胃底静脉曲张的临床疗效。
根据初始治疗及后续治疗情况，将26例患者分为手术组、内镜治疗组和介入放射学组，并比较三组的止血率、根除率和出血率。
介入放射学在100%的病例中成功止住急性出血，而内镜治疗仅在50%的病例中成功。手术组的根除率为100%，内镜治疗组为66.7%，介入放射学组为50%。手术组5年累计出血率为0%，内镜治疗组为0%，介入放射学组为11.1%。三组之间未观察到显著差异。
胃底静脉曲张出血的首选治疗方法是内镜注射硬化疗法和套扎术，若内镜注射硬化疗法和套扎术不成功，则以介入放射学作为备用程序。介入放射学是胃底静脉曲张择期治疗的首选方法。
