球囊阻断静脉逆行泡沫硬化剂闭塞联合内镜注射治疗食道胃底静脉曲张

Balloon-Occluded Retrograde Transvenous Obliteration Combined with Endoscopic Injection of Sclerosing Foam Agent for the Treatment of Esophagogastric Varices

目的探讨球囊阻断逆行静脉闭塞联合内镜注射硬化治疗食道胃底静脉曲张的临床疗效及应用价值。方法 18例食道胃底静脉曲张患者经CT增强扫描,明确有胃后静脉曲张、胃肾分流者,利用球囊阻断静脉逆行泡沫硬化剂注射结合内镜注射硬化治疗食管胃静脉曲张;并发脾功能亢进者,同时行部分脾动脉栓塞。术后观察食管胃静脉曲张、胃肾静脉及其他侧支静脉变化情况,评估手术成功率、患者生存率和食道胃静脉曲张闭塞率。结果17例手术成功,技术成功率94.4%;B-RTO手术硬化剂泡沫用量平均22.4 ml;11例因残留静脉曲张而行内镜硬化剂注射治疗;全部患者仅行1次B-RTO手术;患者1、2年生存率分别为94.1%和88.2%;患者1、2年曲张静脉闭塞率分别为100%和94.1%。结论球囊阻断逆行静脉闭塞联合内镜注射硬化治疗,具有可靠的闭塞曲张静脉效果,降低再出血风险。

Objective To evaluate the clinical efficacy of balloon-occluded retrograde transvenous obliteration（BRTO） with sclerosing foam agent combined with endoscopic injection of sclerosing foam agent in treating esophagogastric varices,and to discuss its clinical application.Methods A total of 18 patients with gastric varices,who had posterior gastric varices and patent gastrorenal shunts,were enrolled in this study.B-RTO with sclerosing foam agent together with endoscopic injection of sclerosing foam agent was carried out in all patients.Additional partial splenic artery emoblization was performed for patients with hypersplenia.After the treatment,the changes of esophagogastric varices,gastrorenal shunts and other collateral veins were evaluated,and the technical success rate,the overall cumulative survival rate and relapse-free rate of gastric varices were calculated.The clinical results were analyzed.Results Technically successful BRTO was accomplished in 17 patients with a technical success rate of 94.4%.The mean used dose of sclerosing foam agent was 22.4 ml.Endoscopic injection sclerotherapy was performed in 11 patients as residual esophagogastric varices were detected after B-RTO.Only one procedure was employed in all patients.The one-year and tow-year survival rate after B-RTO was 94.1% and 88.2% respectively.The relapse-free rate of gastric varices at 1 and 2 years after B-RTO was 100% and94.1% respectively.Conclusion For the treatment of esophagogastric varices,B-RTO combined with endoscopic injection is very effective.This technique can reliably reduce the risk of recurrent bleeding.