| 朱康顺,李征然,何可可,庞鹏飞,关守海,姜在波,黄明声,单鸿.应用NBCA栓塞治疗食管胃底静脉曲张的临床疗效[J].中国医学影像技术,2006,22(12):1866~1869 |
| 应用NBCA栓塞治疗食管胃底静脉曲张的临床疗效 |
| Clinical efficacy of embolization with NBCA for esophageal-gastric fundal varices in portal hypertension |
| 投稿时间：2006-09-16 修订日期：2006-11-22 |
| DOI： |
| 中文关键词: 门静脉高压 静脉曲张,食管胃底静脉 栓塞,治疗性 |
| 英文关键词:Portal hypertension Varices, esophageal-gastric fundal vein Embolization, therapeutic |
| 基金项目:本课题受广东省科技计划项目资助(2004B35001007)。 |
|
| 摘要点击次数: 3172 |
| 全文下载次数: 730 |
| 中文摘要: |
| 目的 探讨应用NBCA栓塞治疗门静脉高压症食管胃底静脉曲张的临床疗效。方法 肝硬化门静脉高压症合并食管胃底静脉曲张患者28例,其中9例为肝癌合并门静脉癌栓。28例中,15例为食管静脉套扎术后再出血者,13例为药物保守治疗后再出血者。28例患者采取经皮经肝或经脾穿刺门静脉造影及曲张静脉的栓塞治疗,栓塞材料为组织黏合剂正丁基-2-氰丙烯酸盐(NBCA),NBCA和超液化碘化油的比例为1∶4~1∶8。对有较大的胃肾分流者,栓塞前经右股静脉、左肾静脉入路,放置球囊导管于分流道,栓塞时球囊扩张阻塞分流道。所有患者栓塞前后进行门静脉压力测定。结果 28例中,27例成功进行胃左静脉、胃后静脉和胃短静脉完全性栓塞,其中8例较大胃肾分流者,栓塞时应用了阻塞球囊技术。门静脉压力由术前(34.7±7.4)cm H2O上升至术后(38.7±4.4)cm H2O(P＜0.05)。4例见少量栓塞剂进入末梢肺动脉,2例出现一过性刺激性咳嗽,无严重的肺栓塞发生。11例患者术后胃镜复查,均显示静脉曲张明显改善。14例患者术后CT增强复查,均显示栓塞的曲张静脉仍完全闭塞,其中3例可见静脉侧支形成。28例患者,随访3~26个月,平均(9.9±6.7)个月,再出血5例(17.9%)。结论 应用NBCA栓塞治疗食管胃底静脉曲张,安全可行,止血效果肯定;但对有较大的胃肾分流者,逆行球囊阻塞分流道是必要的,可防止肺栓塞发生。 |
| 英文摘要: |
| Objective To evaluate the clinical efficacy of embolization with NBCA for esophageal-gastric fundal varices in portal hypertension. Methods Twenty-eight cirrhotic patients with esophageal-gastric fundal varices were enrolled in this study, 9 of which had primary hepatocellular carcinoma with portal venous thrombosis. Before this study, 15 patients received endoscopic variceal ligation, 13 received conservative pharmacotherapy, and all the patients suffered from rebleeding. Percutaneous transhepatic or transplenic portography were performed in all 28 patients; then, esophagogastric varices were embolized with N-butyl-2-cyanoacrylate (NBCA). The proportion of NBCA and lipiodol was determined according to the size and blood flow of varices, ranging from 1∶4 to 1∶8. For the patients who had a large gastrorenal shunt (GRS), a catheter with a balloon was introduced into the GRS via the right femoral and left renal vein before the embolization, and then inflated it to block the flow of GRS. Portal venous pressure was measured before and after embolization in all patients. Results Of the 28 patients, we embolized successfully the left gastric vein, posterior gastric vein and short gastric vein in 27 cases, balloon-occluded technique was applied in 8 patients with large GRS. In these patients, portal venous pressure significantly raised from (34.7±7.4) cm H2O before embolization to (38.7±4.4) cm H2O (P＜0.05) after embolization. In four patients, few NBCA entered into distal pulmonary artery branches. Two of them suffered transient irritable cough; no patient developed severe pulmonary embolism. Endoscopic examination was performed in 11 patients after embolization, which demonstrated that the varices of all the 11 patients were markedly alleviated. In the 14 patients who accepted contrast-enhanced CT exam during 3 to 6 months after the treatment, the embolized varices were still obstructed in all of them, but some other collateral veins were observed in three patients. In this study, the patients were followed up from 3 to 26 months . Rebleeding was observed in 5 patients (17.9%). Conclusion Embolization with NBCA is a safe and effective method for the treatment of esophagogastric varices; but before this procedure, it is necessary to block the large GRS via retrograde approach for preventing pulmonary embolism. |
| 查看全文 查看/发表评论 下载PDF阅读器 |
|
|
|
