Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan.
Eur J Radiol. 2010 Aug;75(2):e32-7. doi: 10.1016/j.ejrad.2009.11.007. Epub 2009 Dec 8.
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).
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.
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.
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.
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。
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。
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。
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。
