胃底静脉曲张栓塞治疗后肝硬化患者长期生存的预处理血流动力学特征。
Pre-treatment hemodynamic features involved with long-term survival of cirrhotic patients after embolization of gastric fundal varices.
机构信息
Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan.
出版信息
Eur J Radiol. 2010 Aug;75(2):e32-7. doi: 10.1016/j.ejrad.2009.11.007. Epub 2009 Dec 8.
PURPOSE
To clarify the pre-treatment hemodynamic features involved in the long-term survival of cirrhotic patients with gastric fundal varices (FV) after balloon-occluded retrograde transvenous obliteration (B-RTO).
MATERIALS AND METHODS
Eighty-one cirrhotic patients with medium- or large-grade FV treated by B-RTO were enrolled in this retrospective study. Pre-treatment flow volume ratio between gastric vein and portal trunk (GP-R) was obtained by Doppler ultrasound.
RESULTS
The cumulative survival rate was 90% at 1 year, 74.8% at 3 years, 57.2% at 5 years, and 45.8% at 7 years without recurrence in a median period of 1148.5 days The survival was poorer in patients with HCC (47% at 3 years, 9.4% at 5 years, p<0.0001) than without (89.2% at 3 years, 81.9% at 5 years, 67.5% at 7 years), in patients with Child B/C (57.7% at 3 years, 42.1% at 5 years, 28.1% at 7 years, p=0.0016) than with Child A (91.8% at 3 years, 71.5% at 5 years, 62.1% at 7 years), and in patients with GP-R > or = 1.0 (58.9% at 3 years, p=0.0485) than with GP-R<1.0 (76.3% at 3 years, 62% at 5 years, 49.6% at 7 years). Multivariate analysis identified the presence of HCC (hazard ratio, 12.486; 95% CI, 4.08-38.216; p<0.0001), Child B/C (hazard ratio, 3.41; 95% CI, 1.594-7.15; p=0.0051) and GP-R > or = 1.0 (hazard ratio, 2.701; 95% CI, 1.07-6.15; p=0.0221) as independent factors for poor prognosis.
CONCLUSION
GP-R > r= 1.0 on Doppler ultrasound before B-RTO may be a predictive indicator for poor prognosis in cirrhotic patients with FV after B-RTO, in addition to the presence of HCC and severe liver damage.
目的
阐明球囊阻断逆行经静脉闭塞术（B-RTO）后肝硬化胃底静脉曲张（FV）患者长期生存的预处理血流动力学特征。
材料与方法
本回顾性研究纳入了 81 例接受 B-RTO 治疗的中-大型 FV 肝硬化患者。通过多普勒超声获得胃静脉与门静脉主干（GP-R）之间的术前血流容积比。
结果
中位随访 1148.5 天，患者 1 年、3 年、5 年和 7 年的累积生存率分别为 90%、74.8%、57.2%和 45.8%，无复发生存率分别为 90%、74.8%、57.2%和 45.8%。合并 HCC 的患者（3 年生存率 47%，5 年生存率 9.4%，p<0.0001）比无 HCC 患者（3 年生存率 89.2%，5 年生存率 81.9%，7 年生存率 67.5%）生存更差，Child B/C 级患者（3 年生存率 57.7%，5 年生存率 42.1%，7 年生存率 28.1%，p=0.0016）比 Child A 级患者（3 年生存率 91.8%，5 年生存率 71.5%，7 年生存率 62.1%）生存更差，GP-R≥1.0 的患者（3 年生存率 58.9%，p=0.0485）比 GP-R<1.0 的患者（3 年生存率 76.3%，5 年生存率 62%，7 年生存率 49.6%）生存更差。多因素分析确定 HCC（风险比，12.486；95%CI，4.08-38.216；p<0.0001）、Child B/C（风险比，3.41；95%CI，1.594-7.15；p=0.0051）和 GP-R≥1.0（风险比，2.701；95%CI，1.07-6.15；p=0.0221）是预后不良的独立因素。
结论
B-RTO 前多普勒超声检查 GP-R≥1.0 可能是 B-RTO 后肝硬化 FV 患者预后不良的预测指标，此外还与 HCC 和严重肝损伤有关。
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