Nakazawa Manabu, Imai Yukinori, Uchiya Hiroshi, Ando Satsuki, Sugawara Kayoko, Nakayama Nobuaki, Tomiya Tomoaki, Mochida Satoshi
Department of Gastroenterology and Hepatology, Faculty of Medicine Saitama Medical University Saitama Japan.
JGH Open. 2017 Dec 5;1(4):127-133. doi: 10.1002/jgh3.12020. eCollection 2017 Dec.
Portosystemic shunts aggravate liver function by decreasing portal blood flow. The usefulness of balloon-occluded retrograde transvenous obliteration (B-RTO), a standardized therapeutic procedure for gastric fundal varices (GFV), for the improvement of liver function was evaluated in cirrhotic patients with or without varices.
The subjects were 161 patients with portosystemic shunts. A balloon catheter was inserted into the shunts, followed by the injection of 5% ethanolamine oleate through the catheter under balloon inflation. The balloon was kept inflated for 6 to 48 h.
B-RTO was performed as a therapy for GFV in 112 patients and for the improvement of liver function in 49 patients. The targets were splenorenal shunts in 104 patients (93.6%) in the former group and 33 patients (67.3%) in the latter group, and the procedures were successfully completed in 109 (97.3%) and 39 (79.6%) patients, respectively. In both groups, the serum albumin levels were increased and the serum ammonia levels were decreased at more than 1 month after the procedures, compared with the baseline levels, whereas significant improvements in the Child-Pugh scores and prothrombin times were only seen in the latter group. In these patients, the portal blood flows evaluated using Doppler ultrasound were increased at 1 week after the procedures, compared with the baseline levels.
B-RTO is a useful therapeutic procedure for improving liver function even in patients without GFV by increasing the portal venous flow with successfully targeted, uncommon portosystemic shunts.
门体分流通过减少门静脉血流加重肝功能损害。本研究评估了球囊闭塞逆行静脉栓塞术（B-RTO）这一治疗胃底静脉曲张（GFV）的标准化治疗方法，对合并或不合并静脉曲张的肝硬化患者肝功能改善情况的影响。
研究对象为161名门体分流患者。将球囊导管插入分流处，然后在球囊充盈状态下经导管注入5%油酸乙醇胺。球囊保持充盈6至48小时。
112例患者接受B-RTO治疗GFV，49例患者接受B-RTO治疗以改善肝功能。前一组104例患者（93.6%）的目标是脾肾分流，后一组33例患者（67.3%）的目标是脾肾分流，两组分别有109例（97.3%）和39例（79.6%）患者成功完成手术。两组患者术后1个月以上血清白蛋白水平均升高，血清氨水平均降低，与基线水平相比，而Child-Pugh评分和凝血酶原时间仅在后一组有显著改善。在这些患者中，与基线水平相比，术后1周使用多普勒超声评估的门静脉血流增加。
B-RTO是一种有效的治疗方法，即使对于没有GFV的患者，通过成功靶向不常见的门体分流增加门静脉血流，也可改善肝功能。
