Zhang Chun-qing, Liu Fu-li, Xu Hong-wei, Feng Kai, Zhu Qiang, Zhang Jun-yong, Xu Lin
Department of Gastroenterology, Shandong Provincial Hospital, Jinan 250021, China.
Zhonghua Yi Xue Za Zhi. 2007 Dec 25;87(48):3389-93.
To test the safety and validity of percutaneous transhepatic variceal embolization (PTVE) with tissue adhesive cyanoacrylate.
PTVE with cyanoacrylate was performed on 92 patients with gastroesophageal varices, 53 males and 39 females, aged 62.5 (7-84): cyanoacrylate was injected into the varices and the afferent veins. Endoscopy and CT were performed to evaluate the embolization.
PTVE was successfully completed in 89 of the 92 patients with a technical success rate of 96.7%, and 3 patients died within 1 month. Among the other 86 patients 3 types of cyanoacrylate embolization were achieved: embolization of coronary vein, vessels around gastric fundus, and variceal lower esophagus veins in 40 patients, embolization of coronary vein, gastric fundus and pericardial varices in 33 patients, and embolization of sole gastric coronary vein stem in 13 patients. Acute variceal bleeding in 18 patients was immediately arrested after the procedure, with an acute bleeding control rate of 100%. Eighty-six patients were followed up for 31.5 (6-52) months. The general variceal recurrence rate was 14.1% (10/71), and the variceal recurrence rate of the coronary vein embolization group was 100% (2/2), significantly higher than those of the groups of esophagus and fundus embolization and gastric fundus and cardia varices embolization [7.5% (3/40) and 17.2% (5/29) respectively, P = 0.006]. The general rebleeding rate was 16.3% (14/86), and the rebleeding rates of the group of coronary vein embolization was 69.2% (9/13), significantly higher than those of the groups of esophagus and fundus embolization and gastric fundus and cardia varices embolization [7.5% (3/40) and 15. 2% (5/33) respectively, P = 0.0092]. No obvious ectopic embolization was found. The mortality was 24.7% (22/89). The cause of rebleeding in coronary vein embolization was mainly recurrent variceal bleeding, whereas that in the group of fundus and esophagus variceal embolization was mainly hypertensive gastropathy.
PTVE with cyanoacrylate is safe and effective for the obliteration of gastroesophageal varices in cirrhotic patients.
检验使用氰基丙烯酸酯组织黏合剂进行经皮经肝门静脉栓塞术（PTVE）的安全性和有效性。
对92例胃食管静脉曲张患者实施氰基丙烯酸酯PTVE，其中男性53例，女性39例，年龄62.5岁（7 - 84岁）：将氰基丙烯酸酯注入曲张静脉和流入静脉。进行内镜检查和CT以评估栓塞情况。
92例患者中有89例成功完成PTVE，技术成功率为96.7%，3例患者在1个月内死亡。在其他86例患者中实现了3种氰基丙烯酸酯栓塞类型：40例患者栓塞冠状静脉、胃底周围血管和食管下段曲张静脉，33例患者栓塞冠状静脉、胃底和心包曲张静脉，13例患者仅栓塞胃冠状静脉主干。18例急性曲张静脉出血患者术后立即止血，急性出血控制率为100%。86例患者随访31.5个月（6 - 52个月）。总体曲张静脉复发率为14.1%（10/71），冠状静脉栓塞组曲张静脉复发率为100%（2/2），显著高于食管和胃底栓塞组以及胃底和贲门曲张静脉栓塞组[分别为7.5%（3/40）和17.2%（5/29），P = 0.006]。总体再出血率为16.3%（14/86），冠状静脉栓塞组再出血率为69.2%（9/13），显著高于食管和胃底栓塞组以及胃底和贲门曲张静脉栓塞组[分别为7.5%（3/40）和15.2%（5/33），P = 0.0092]。未发现明显的异位栓塞。死亡率为24.7%（22/89）。冠状静脉栓塞再出血的原因主要是曲张静脉复发出血，而胃底和食管曲张静脉栓塞组主要是高血压性胃病。
使用氰基丙烯酸酯进行PTVE对肝硬化患者胃食管静脉曲张的闭塞是安全有效的。
