Cho Sung Ki, Shin Sung Wook, Yoo Eun Young, Do Young Soo, Park Kwang Bo, Choo Sung Wook, Han Heon, Choo In Wook
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Radiol. 2007 Nov-Dec;8(6):520-30. doi: 10.3348/kjr.2007.8.6.520.
We wanted to evaluate the short-term effects of balloon-occluded retrograde transvenous obliteration (BRTO) for treating gastric variceal bleeding, in terms of the portal hypertensive changes, by comparing CT scans.
We enrolled 27 patients who underwent BRTO for gastric variceal bleeding and they had CT scans performed just before and after BRTO. The pre- and post-procedural CT scans were retrospectively compared by two radiologists working in consensus to evaluate the short-term effects of BRTO on the subsequent portal hypertensive changes, including ascites, splenomegaly, portosystemic collaterals (other than gastrorenal shunt), the gall bladder (GB) edema and the intestinal wall edema. Statistical differences were analyzed using the Wilcoxon signed rank test and the paired t-test.
Following BRTO, ascites developed or was aggravated in 22 (82%) of 27 patients and it was improved in two patients; the median spleen volumes increased from 438.2 cm(3) to 580.8 cm(3), and based on a 15% volume change cut-off value, splenic enlargement occurred in 15 (56%) of the 27 patients. The development of new collaterals or worsening of existing collaterals was not observed in any patient. GB wall edema developed or was aggravated in four of 23 patients and this disappeared or improved in five; intestinal wall edema developed or was aggravated in nine of 27 patients, and this disappeared or improved in five. Statistically, we found significant differences for ascites and the splenic volumes before and after BRTO (p = 0.001 and p < 0.001, respectively)
Some portal hypertensive changes, including ascites and splenomegaly, can be aggravated shortly after BRTO.
我们希望通过比较CT扫描结果，从门静脉高压变化方面评估球囊闭塞逆行静脉栓塞术（BRTO）治疗胃静脉曲张出血的短期效果。
我们纳入了27例行BRTO治疗胃静脉曲张出血的患者，并在BRTO前后均进行了CT扫描。由两位放射科医生对术前和术后的CT扫描结果进行回顾性比较，以评估BRTO对后续门静脉高压变化的短期影响，包括腹水、脾肿大、门体分流（脾肾分流除外）、胆囊（GB）水肿和肠壁水肿。使用Wilcoxon符号秩检验和配对t检验分析统计学差异。
BRTO后，27例患者中有22例（82%）出现腹水或腹水加重，2例患者腹水有所改善；脾脏体积中位数从438.2 cm³增加到580.8 cm³，以15%的体积变化临界值为标准，27例患者中有15例（56%）出现脾脏增大。未观察到任何患者出现新的侧支循环形成或现有侧支循环恶化。23例患者中有4例出现GB壁水肿或水肿加重，5例患者水肿消失或改善；27例患者中有9例出现肠壁水肿或水肿加重，5例患者水肿消失或改善。在统计学上，我们发现BRTO前后腹水和脾脏体积存在显著差异（分别为p = 0.001和p < 0.001）。
BRTO术后短期内，包括腹水和脾肿大在内的一些门静脉高压变化可能会加重。
