通过胃左动脉造影静脉期验证内镜下注射硬化剂联合结扎术治疗食管胃静脉曲张后血栓形成情况。
Verification of thrombus formation just after endoscopic injection sclerotherapy with ligation for esophagogastric varices by venous phase of left gastric arteriography.
作者信息
Chikamori Fumio, Kanazawa Shunsuke, Sharma Niranjan
机构信息
Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi 780-8562, Japan.
Department of Gastroenterology, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi 780-8562 Japan.
出版信息
Radiol Case Rep. 2022 Aug 27;17(11):4069-4074. doi: 10.1016/j.radcr.2022.07.098. eCollection 2022 Nov.
Management of hepatic venous pressure gradient (HVPG) is important in the treatment of portal hypertension. We report a case that was treated by a hybrid procedure combining endoscopic injection sclerotherapy with ligation (EISL), left gastric artery embolization (LGE), and partial splenic artery embolization (PSE) based on a new concept ``splanchnic caput Medusae.'' The venous phase of left gastric arteriography just after EISL demonstrated thrombus formation in the gastric varices and the cardiac branch of the left gastric vein. The para-esophageal vein and lesser curvature branch of the left gastric vein were not affected. HVPG decreased from 14 to 11 mmHg immediately after LGE and PSE. 3D-CT reconstruction portal image revealed that the portal system reversed to almost normal form. This is the first case report in which thrombus formation in gastric varices and cardiac branch just after EISL could be demonstrated by the venous phase of left gastric arteriography.
肝静脉压力梯度（HVPG）的管理在门静脉高压症的治疗中至关重要。我们报告了一例采用基于“内脏水母头”新概念的内镜注射硬化疗法联合结扎术（EISL）、胃左动脉栓塞术（LGE）和部分脾动脉栓塞术（PSE）的杂交手术进行治疗的病例。EISL后即刻的胃左动脉造影静脉期显示胃静脉曲张和胃左静脉的心支内形成血栓。食管旁静脉和胃左静脉的小弯支未受影响。LGE和PSE后即刻，HVPG从14 mmHg降至11 mmHg。三维CT重建门静脉图像显示门静脉系统几乎恢复至正常形态。这是首例通过胃左动脉造影静脉期证实EISL后即刻胃静脉曲张和心支内形成血栓的病例报告。
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