Mukund Amar, Deogaonkar Ganesh, Rajesh S, Shasthry Saggerre Muralikrishna, Sarin Shiv Kumar
Department of Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi, 110070, India.
Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, Off Abdul Gaffar Khan Marg, New Delhi, 110070, India.
Cardiovasc Intervent Radiol. 2017 Jul;40(7):1010-1016. doi: 10.1007/s00270-017-1593-5. Epub 2017 Feb 8.
To evaluate the safety and efficacy sodium tetradecyl sulfate and lipiodol foam (STS foam) in BRTO for large (caliber ≥15 mm) porto-systemic shunt and gastric fundal varices.
It is a retrospective record-based study of patients who underwent BRTO using STS foam at the Institute of Liver and Biliary Sciences, New Delhi, for gastric variceal bleed or refractory hepatic encephalopathy (HE) who had large porto-systemic shunt (diameter ≥15 mm) with or without associated gastric varices. Clinical and laboratory parameters were evaluated before and after the procedure. All patients were followed for minimum of 12 months.
Records of 22 patients were analyzed. Technical success was achieved in 22 of 22 sessions. Complete obliteration of shunt with clinical improvement was seen in 20 of 22 cases. Patients with gastric varices had no residual gastric varices on follow-up endoscopy. There were significant reduction in CTP scores and improvement in HE grades following BRTO. Post-procedure complication was encountered in 6 patients (5 minor and 1 major), and 7 patients showed worsening of esophageal varices and underwent endoscopic variceal ligation. One patient had succumbed to septicemia at a follow-up of 34 months.
Our experience suggests STS foam is a safe and effective agent for patients with large shunt undergoing BRTO.
评估十四烷基硫酸钠与碘油泡沫（STS泡沫）在经皮球囊闭塞下逆行性经静脉栓塞术（BRTO）治疗大口径（≥15毫米）门静脉系统分流和胃底静脉曲张中的安全性和有效性。
这是一项基于回顾性记录的研究，研究对象为在新德里肝胆科学研究所接受使用STS泡沫进行BRTO治疗的患者，这些患者因胃静脉曲张出血或难治性肝性脑病（HE）而患有大口径门静脉系统分流（直径≥15毫米），伴有或不伴有相关胃静脉曲张。在手术前后评估临床和实验室参数。所有患者至少随访12个月。
分析了22例患者的记录。22次手术中有22次取得技术成功。22例中有20例分流完全闭塞且临床症状改善。胃静脉曲张患者在随访内镜检查中无残留胃静脉曲张。BRTO后CTP评分显著降低，HE分级改善。6例患者出现术后并发症（5例轻微，1例严重），7例患者食管静脉曲张恶化并接受内镜下静脉曲张结扎术。1例患者在34个月的随访中死于败血症。
我们的经验表明，STS泡沫对于接受BRTO的大分流患者是一种安全有效的药物。
