Tie Jun, Yuan Xulong, Zhu Ying, Li Kai, Gou Xiaoyuan, Han Na, Niu Jing, Xu Jiao, Wang Wenlan, Shi Yongquan
State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, Shaanxi, China.
Department of Aerospace Hygiene, School of Aerospace Medicine, Air Force Medical University, Xi'an, Shaanxi, China.
Front Med (Lausanne). 2024 Jul 15;11:1401900. doi: 10.3389/fmed.2024.1401900. eCollection 2024.
Nonselective beta blockers (NSBBs) or endoscopic therapies are currently recommended by guidelines for preventing the first variceal bleed in patients with high-risk varices. However, there is a lack of detailed treatment strategies for patients who are intolerant to both NSBBs and endoscopic approaches. Our study aimed to assess the efficacy and safety of variceal embolization as a primary prophylaxis method in cirrhosis patients who are not suitable candidates for NSBBs or endoscopic treatments.
The study included 43 cirrhotic patients with high-risk varices who were candidates for primary prophylaxis against variceal bleeding. These patients underwent variceal embolization at the Xijing Hospital between January 2020 and June 2022. The primary endpoint was the occurrence of bleeding from varices, and the secondary endpoints were the recurrence of varices and the emergence of complications.
The procedure of variceal embolization had a success rate of 93.0% (40 out of 43 patients). Over a 2-year follow-up period, the rate of variceal bleeding was 11.6% (5 out of 43 patients), the recurrence rate of varices was 14.0% (6 out of 43 patients), and the rate of severe complications was limited to 2.3% (1 out of 43 patients).
Variceal embolization is a viable primary prophylactic intervention for cirrhotic patients who are at risk of variceal bleeding when standard treatments, such as NSBBs or endoscopic therapies, are difficult to perform.
目前指南推荐使用非选择性β受体阻滞剂（NSBBs）或内镜治疗来预防高危静脉曲张患者首次发生静脉曲张破裂出血。然而，对于不耐受NSBBs和内镜治疗的患者，缺乏详细的治疗策略。我们的研究旨在评估静脉曲张栓塞作为一种一级预防方法，在不适合使用NSBBs或内镜治疗的肝硬化患者中的疗效和安全性。
该研究纳入了43例有静脉曲张破裂出血一级预防指征的高危静脉曲张肝硬化患者。这些患者于2020年1月至2022年6月在西京医院接受了静脉曲张栓塞治疗。主要终点是静脉曲张出血的发生情况，次要终点是静脉曲张复发和并发症的出现。
静脉曲张栓塞手术成功率为93.0%（43例患者中的40例）。在2年的随访期内，静脉曲张出血率为11.6%（43例患者中的5例），静脉曲张复发率为14.0%（43例患者中的6例），严重并发症发生率仅为2.3%（43例患者中的1例）。
对于在难以实施NSBBs或内镜治疗等标准治疗时存在静脉曲张破裂出血风险的肝硬化患者，静脉曲张栓塞是一种可行的一级预防干预措施。
