球囊逆行阻断胃肾分流道联合经皮肝穿胃静脉栓塞治疗伴胃肾分流道的胃静脉曲张

Gastric varices with spontaneous gastrorenal shunt： treated by retrograde gastrorenal shunt balloon occlusion combined with percutaneous transhepatic gastric varices embolization

目的 评价球囊逆行阻断胃肾分流道联合经皮肝穿胃静脉栓塞,治疗自发胃肾分流道形成的胃静脉曲张的临床疗效和安全性.方法 8例男性自发胃肾分流道形成的胃静脉曲张患者,年龄40～61岁,平均（50±8）岁,行经股静脉球囊逆行阻断胃肾分流道联合经皮肝穿胃静脉栓塞治疗.结果 8例患者于术成功,术后门静脉压力平均增高5.5 cm H2O（1 cm H2O=0.098 kPa,手术前为35.0～41.0 cm H2O,手术后为39.0～45.5 cm H2O）.本组患者术后随访1～46个月,随访期内均未再发消化道出血.结论 球囊逆行阻断胃肾分流道联合经皮肝穿胃静脉栓塞,治疗自发胃肾分流道形成的胃静脉曲张是安全可行的,可作为治疗难以采用内镜下硬化止血治疗的自发胃肾分流道形成的胃静脉曲张的有效方法.

Objective To evaluate the efficacy and the safety of retrograde gastrorenal shunt balloon occlusion combined with percutaneous transhepatic gastric varices embolization to treat the gastric varices with spontaneous gastrorenal shunt. Methods From Nov. 2006 to Jun. 2010, retrograde gastrorenal shunt balloon occlusion combined with percutaneous transhepatic gastric varices embolization was performed on 8 patients who had gastric varices with spontaneous gastrorenal shunt. All the patients were men and the age ranged from 40 to 61 years. The balloon catheter was inserted into the spontaneous gastrorenal shunt through the right femoral vein, then percutaneous transhepatic splenic vein venograghy was performed to identify the number and morphology of gastric varices. After that gastric varices embolization was performed while the balloon catheter was dilated, which was withdrawn one day after the procedure. Results Technical success of interventional treatment was achieved in all 8 cases with no significant complications. The increase of average portal venous pressure was 5.5 cm H2O （1 cm H2O = 0. 098 kPa,preoperative 35.0 to 41.0 cm H2O,postoperative 39.0 to 45.5 cm H2O）. After follow up of 1 to 46 months, no recurrence haemorrhage occurred. Conclusion Retrograde gastrorenal shunt balloon occlusion combined with percutaneous transhepatie gastric variees embolization can be safely performed and could be one of the effective choices for patients who had gastric varices with spontaneous gastrorenal shunt, which is not suitable to treat by the endoscopic sclerotherapy.