Chang Min-Yung, Kim Man-Deuk, Kim Taehwan, Shin Wonseon, Shin Minwoo, Kim Gyoung Min, Won Jong Yun, Park Sung Il, Lee Do Yun
Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
Department of Radiology, National Health Insurance Serivce Ilsan Hospital, Goyang 10444, Korea.
Korean J Radiol. 2016 Mar-Apr;17(2):230-8. doi: 10.3348/kjr.2016.17.2.230. Epub 2016 Mar 2.
To evaluate the feasibility, safety, and clinical outcomes of plug-assisted retrograde transvenous obliteration (PARTO) to treat gastric variceal hemorrhage in patients with portal hypertension.
From May 2012 to June 2014, 19 patients (11 men and 8 women, median age; 61, with history of gastric variceal hemorrhage; 17, active bleeding; 2) who underwent PARTO using a vascular plug and a gelfoam pledget were retrospectively analyzed. Clinical and laboratory data were examined to evaluate primary (technical and clinical success, complications) and secondary (worsening of esophageal varix [EV], change in liver function) end points. Median follow-up duration was 11 months, from 6.5 to 18 months. The Wilcoxon signed-rank test was used to compare laboratory data before and after the procedure.
Technical success (complete occlusion of the efferent shunt and complete filling of gastric varix [GV] with a gelfoam slurry) was achieved in 18 of 19 (94.7%) patients. The embolic materials could not reach the GV in 1 patient who had endoscopic glue injection before our procedure. The clinical success rate (no recurrence of gastric variceal bleeding) was the same because the technically failed patient showed recurrent bleeding later. Acute complications included fever (n = 2), fever and hypotension (n = 2; one diagnosed adrenal insufficiency), and transient microscopic hematuria (n = 3). Ten patients underwent follow-up endoscopy; all exhibited GV improvement, except 2 without endoscopic change. Five patients exhibited aggravated EV, and 2 of them had a bleeding event. Laboratory findings were significantly improved after PARTO.
PARTO is technically feasible, safe, and effective for gastric variceal hemorrhage in patients with portal hypertension.
评估经皮经肝穿刺门静脉栓塞术（PARTO）治疗门静脉高压症患者胃静脉曲张出血的可行性、安全性及临床疗效。
回顾性分析2012年5月至2014年6月期间19例行PARTO治疗的患者（11例男性，8例女性，中位年龄61岁；有胃静脉曲张出血史19例，其中17例为活动性出血，2例为非活动性出血），术中使用血管栓塞剂和明胶海绵。检查临床和实验室数据，以评估主要终点（技术和临床成功、并发症）和次要终点（食管静脉曲张[EV]加重、肝功能变化）。中位随访时间为11个月（6.5至18个月）。采用Wilcoxon符号秩检验比较术前和术后的实验室数据。
19例患者中有18例（94.7%）技术成功（分流支完全闭塞，明胶海绵浆液完全填充胃静脉曲张[GV]）。1例在我们手术前已行内镜下注射胶水的患者，栓塞材料未能到达GV。临床成功率（胃静脉曲张出血无复发）相同，因为技术失败的患者随后出现复发出血。急性并发症包括发热（2例）、发热和低血压（2例，其中1例诊断为肾上腺功能不全）、短暂镜下血尿（3例）。10例患者接受了随访内镜检查；除2例内镜检查无变化外，其余均显示GV改善。5例患者EV加重，其中2例发生出血事件。PARTO术后实验室检查结果明显改善。
PARTO治疗门静脉高压症患者胃静脉曲张出血在技术上是可行的、安全有效的。
