经皮经肝曲张静脉栓塞术联合 2-辛基氰基丙烯酸酯治疗胃静脉曲张出血：长期随访结果。

Modified percutaneous transhepatic variceal embolization with 2-octylcyanoacrylate for bleeding gastric varices: long-term follow-up outcomes.

机构信息

Department of Gastroenterology, Provincial Hospital Affiliated to Shandong University, 324 Jingwu Weiqi Rd, Jinan 250021, China.

出版信息

AJR Am J Roentgenol. 2011 Aug;197(2):502-9. doi: 10.2214/AJR.10.6005.

DOI:10.2214/AJR.10.6005

PMID:21785101

Abstract

OBJECTIVE

The objective of our study was to evaluate the long-term efficacy and safety of a modified percutaneous transhepatic variceal embolization procedure with 2-octylcyanoacrylate (2-OCA) in the treatment of gastric variceal bleeding.

MATERIALS AND METHODS

From January 2003 to December 2008, 71 patients with a history of gastric variceal bleeding underwent modified percutaneous transhepatic variceal embolization with 2-OCA in our hospital: 12 patients with acute gastric variceal bleeding underwent emergency obliteration and the remaining 59 patients with recent variceal bleeding underwent modified percutaneous transhepatic variceal embolization as a secondary prophylaxis. The initial hemostasis rate, rebleeding rate, survival rate, and complications were evaluated.

RESULTS

Complete obliteration--that is, all the gastric varices and their feeding veins were obliterated--was achieved after the percutaneous transhepatic variceal embolization procedure in 67 patients (94.4%). Acute variceal bleeding was arrested after the procedure in all 12 patients (100%). The mean follow-up period was 24.2 ± 12.4 (SD) months (range, 6-62 months). During the follow-up period, the cumulative probability of remaining free of gastric variceal rebleeding in patients with complete obliteration was 100%, 88.2%, and 88.2% at 1, 3, and 5 years after the procedure, respectively. Follow-up CT revealed that the modified percutaneous transhepatic variceal embolization procedure with 2-OCA can achieve long-lasting obliteration in the entire varices and in all the feeding veins. The cumulative survival rates at 1, 3, and 5 years after the procedure were 96.9%, 68.9%, and 53.7%. No severe complications occurred after the procedure.

CONCLUSION

The modified percutaneous transhepatic variceal embolization with 2-OCA is considered to be an effective and safe method for the extensive and permanent obliteration of both gastric varices and their feeding veins.

摘要

目的

本研究旨在评估经皮经肝胃静脉曲张栓塞术联合 2-辛基氰基丙烯酸酯（2-OCA）治疗胃静脉曲张出血的长期疗效和安全性。

材料和方法

2003 年 1 月至 2008 年 12 月，我院对 71 例胃静脉曲张出血患者进行了改良经皮经肝胃静脉曲张栓塞术联合 2-OCA 治疗：12 例急性胃静脉曲张出血患者行急诊闭塞术，59 例近期胃静脉曲张出血患者行改良经皮经肝胃静脉曲张栓塞术作为二级预防。评估初始止血率、再出血率、生存率和并发症。

结果

67 例（94.4%）患者经经皮经肝胃静脉曲张栓塞术完全闭塞，即所有胃静脉曲张及其供血静脉均闭塞。12 例急性胃静脉曲张出血患者术后均即刻止血（100%）。平均随访时间为 24.2±12.4（SD）个月（6-62 个月）。随访期间，完全闭塞患者无胃静脉曲张再出血的累积概率分别为 100%、88.2%和 88.2%，术后 1、3、5 年。随访 CT 显示，2-OCA 改良经皮经肝胃静脉曲张栓塞术可使整个静脉曲张及其所有供血静脉达到持久闭塞。术后 1、3、5 年的累积生存率分别为 96.9%、68.9%和 53.7%。术后无严重并发症发生。