Treatment of portosystemic shunt-borne hepatic encephalopathy in a 97-year-old woman using balloon-occluded retrograde transvenous obliteration:A case report

BACKGROUND Hyperammonemia and hepatic encephalopathy are common in patients with portosystemic shunts.Surgical shunt occlusion has been standard treatment,although recently the less invasive balloon-occluded retrograde transvenous obliteration(B-RTO)has gained increasing attention.Thus far,there have been no reports on the treatment of portosystemic shunts with B-RTO in patients aged over 90 years.In this study,we present a case of hepatic encephalopathy caused by shunting of the left common iliac and inferior mesenteric veins,successfully treated with B-RTO.CASE SUMMARY A 97-year-old woman with no history of liver disease was admitted to our hospital because of disturbance of consciousness.She had no jaundice,spider angioma,palmar erythema,hepatosplenomegaly,or asterixis.Her blood tests showed hyperammonemia,and abdominal contrast-enhanced computed tomography revealed a portosystemic shunt running between the left common iliac vein and the inferior mesenteric vein.She was diagnosed with hepatic encephalopathy secondary to a portosystemic shunt.The patient did not improve with conservative treatment:Lactulose,rifaximin,and a low-protein diet.B-RTO was performed,which resulted in shunt closure and improvement in hyperammonemia and disturbance of consciousness.Moreover,there was no abdominal pain or elevated levels of liver enzymes due to complications.The patient was discharged without further consciousness disturbance.CONCLUSION Portosystemic shunt-borne hepatic encephalopathy must be considered in the differential diagnosis for consciousness disturbance,including abnormal behavior and speech.

Successful balloon-occluded retrograde transvenous obliteration for bleeding duodenal varices using cyanoacrylate

A 76-year-old woman with hepatitis C cirrhosis presented with tarry stools and hematemesis.An endoscopy demonstrated bleeding duodenal varices in the second portion of the duodenum.Contrast-enhanced computed tomography revealed markedly tortuous varices around the wall in the duodenum.Several afferent veins appeared to have developed,and the right ovarian vein draining into the inferior vena cava was detected as an efferent vein.Balloon-occluded retrograde transvenous obliteration (BRTO) of the varices using cyanoacrylate was successfully performed in combination with the temporary occlusion of the portal vein.Although no previous publications have used cyanoacrylate as an embolic agent for BRTO to control bleeding duodenal varices,this strategy can be considered as an alternative procedure to conventional BRTO using ethanolamine oleate when numerous afferent vessels that cannot be embolized are present.

Emergency balloon-occluded retrograde transvenous obliteration of ruptured gastric varices

AIM: To evaluate the effectiveness and safety of emergency balloon-occluded retrograde transvenous obliteration(BRTO) for ruptured gastric varices.METHODS: Emergency BRTO was performed in 17 patients with gastric varices and gastrorenal or gastrocaval shunts within 24 h of hematemesis and/or tarry stool.The gastric varices were confirmed by endoscopy,and the gastrorenal or gastrocaval shunts were identified by contrast-enhanced computed tomography(CE-CT).A 6-Fr balloon catheter(Cobra type) was inserted into the gastrorenal shunt via the right internal jugular vein,or into the gastrocaval shunt via the right femoral vein,depending on the varices drainage route.The sclerosant,5% ethanolamine oleate iopamidol,was injected into the gastric varices through the catheter during balloon occlusion.In patients with incom plete thrombosis of the varices after the first BRTO,a second BRTO was performed the following day.Patients were followed up by endoscopy and CE-CT at 1 d,1 wk,and 1,3 and 6 mo after the procedure,and every 6 mo thereafter.RESULTS: Complete thrombosis of the gastric varices was not achieved with the first BRTO in 7/17 patients because of large gastric varices.These patients underwent a second BRTO on the next day,and additional sclerosant was injected through the catheter.Complete thrombosis which led to disappearance of the varices was achieved in 16/17 patients,while the remaining patient had incomplete thrombosis of the varices.None of the patients experienced rebleeding or recurrence of the gastric varices after a median follow-up of 1130 d(range 8-2739 d).No major complications occurred after the procedure.However,esophageal varices worsened in 5/17 patients after a mean follow-up of 8.6 mo.CONCLUSION: Emergency BRTO is an effective and safe treatment for ruptured gastric varices.

Balloon-occluded retrograde transvenous obliteration for gastric varices via the intercostal vein

Gastric varices are usually associated with a gastrorenal(G-R) shunt.However,the gastric varices described in this case report were not associated with a G-R shunt.The inflow vessel was the posterior gastric vein and the outflow vessels were the narrow inferior phrenic vein and the dilated cardio-phrenic vein.First,percutaneous transhepatic obliteration of the posterior gastric vein was performed,but the gastric varices remained patent.Then,micro-balloon catheterization of the subphrenic vein was carried out via the jugular vein,pericardial vein and cardio-phrenic vein,however,micro-balloon-occluded inferior phrenic venography followed by micro-coil embolization of the cardio-phrenic vein revealed no delineation of gastric varices resulting in no further treatment.Thereafter,as a gastrosubphrenic-intercostal vein shunt developed,a microballoon catheter was advanced to the gastric varices via the intercostal vein and balloon-occluded retrograde transvenous obliteration(BRTO) was performed resulting in the eradication of gastric varices.BRTO for gastric varices via the intercostal vein has not previously been documented.

Balloon-occluded retrograde transvenous obliteration for treatment of gastric varices

Rupture of gastric varices(GVs)can be fatal.Balloon-occluded retrograde transvenous obliteration(BRTO),as known as retrograde sclerotherapy,has been widely adopted for treatment of GVs because of its effectiveness,ability to cure,and utility in emergency and prophylactic treatment.Simplifying the route of blood flow from GVs to the gastrorenal shunt is important for the successful BRTO.This review outlines BRTO indications and contraindications,describes basic BRTO procedures and modifications,compares BRTO with other GVs treatments,and discusses various combination therapies.Combined BRTO and partial splenic embolization may prevent exacerbation of esophageal varices and shows promise as a treatment option.

Efficacy of balloon-occluded retrograde transvenous obliteration, percutaneous transhepatic obliteration and combined techniques for the management of gastric fundal varices

AIM： To evaluate the effect of three interventional treatments involving transvenous obliteration for the treatment of gastric varices, and to compare the efficacy and adverse effects of these methods, METHODS： From 1995 to 2004, 93 patients with gastric fundal varices underwent interventional radiologic embolotherapy at our hospital. Of the 93 patients, 75 were treated with the balloon-occluded retrograde transvenous obliteration （BRTO） procedure; 8 were with the percutaneous transhepatic obliteration （PTO） procedure; and 10 were with the combined BRTO and PTO therapy. A follow-up evaluation examined the rates of survival, recurrence and rebleeding of the gastric varices, worsening of esophageal varices and complications in each group. RESULTS： The BRTO, PTO, and combined therapy were technically successful in 81% （75/93）, 44% （8/18）, and 100% （10/10） patients, respectively. Recurrence of gastric varices was found in 3 patients in the BRTO group and in 3 patients in the PTO group. Rebleeding was observed in 1 patient in the BRTO group and in 1 patient in the PTO group. The 1- and 3-year survival rates were 98% and 87% in the patients without hepatocellular carcinoma （HCC） in the BRTO group, 100% and 100% in the PTO group, and 90% and 75% in the combined therapy group, respectively. CONCLUSION： Combined BRTO and PTO therapy may rescue cases with uncontrollable gastric fundal varices that remained even after treatment with BRTO and/or PTO, though there were limitations of our study, including retrospective nature and discrepancy in sample size between the BRTO, PTO and combined therapy groups.

Mastoid obliteration and reconstruction techniques:A review of the literature

Objective To review the published literature related to the different obliteration and reconstruction techniques in the management of the canal wall down mastoidectomy.Methods A PubMed(Medline)and LILACS databases as well as crossed references search was performed with the following Mesh terms:“cholesteatoma”,“cholesteatoma-middle ear”,“otitis media”,“otitis media,suppurative”,“mastoiditis”,“mastoidectomy”,“canal wall down mastoidectomy”,“radical mastoidectomy”,“mastoid obliteration”and crossed references.Inclusion criteria were adult patients subject to mastoid cavity obliteration and posterior canal wall reconstruction.The technique and materials used,anatomic and functional results,complications,recurrence rates,and changes in quality of life,were analyzed.A total of 94 articles were screened,38 were included for full-text detailed review.Results Twenty-one articles fulfilled the inclusion criteria.Techniques and materials used for canal wall reconstruction,tympanoplasty,and ossiculoplasty were varied and included autologous,biosynthetic,or both.Auditory results were reported in 16 studies and were inconsistent.Three studies reported improvement in the quality of life using the GBI scale.Follow-up time ranged from 1 to 83 months.Eleven articles used imaging studies to evaluate postoperative disease recurrence.The highest recurrence rate reported for cholesteatoma after obliteration was 19%.The most frequently reported complications were retraction pockets and transient otorrhea.Conclusion Plenty of techniques combining grafts and other materials have been used to overcome mastoidectomy cavity problems.So far,it is still not possible to standardize an ideal procedure.The available level of evidence for this topic is low and limited.

Transhepatic catheter-directed thrombolysis for portal vein thrombosis after partial splenic embolization in combination with balloon-occluded retrograde transvenous obliteration of splenorenal shunt

A 66-year-old woman underwent partial splenic embolization （PSE） for hypersplenisrn with idiopathic portal hypertension （IPH）. One week later, contrast-enhanced CT revealed extensive portal vein thrombosis （PVT） and dilated portosystemic shunts. The PVT was not dissolved by the intravenous administration of urokinase. The right portal vein was canulated via the percutaneous transhepatic route under ultrasonic guidance and a 4 Fr. straight catheter was advanced into the portal vein through the thrombus. Transhepatic catheter-directed thrombolysis was performed to dissolve the PVT and a splenorenal shunt was concurrently occluded to increase portal blood flow, using balloon-occluded retrograde transvenous obliteration （BRTO） technique. Subsequent contrast-enhanced CT showed good patency of the portal vein and thrombosed splenorenal shunt. Transhepatic catheter-directed thrombolysis combined with BRTO is feasible and effective for PVT with portosystemic shunts.

Duodenal variceal bleeding after balloon-occluded retrograde transverse obliteration: Treatment with transjugular intrahepatic portosystemic shunt

We report a case of duodenal varix bleeding as a long term complication of balloon occluded retrograde transvenous obliteration (BRTO), which was successfully treated with a transjugular intrahepatic portosystemic shunt (TIPS). A 57-year-old man was admitted to the emergency room suffering from melena. He had under-gone BRTO to treat gastric varix bleeding 5 mo before admission. Endoscopy and a computed tomography (CT) scan showed complete obliteration of the gastric varix, but the nodular varices in the second portion of the duodenum expanded after BRTO, and spurting blood was seen. TIPS was performed for treatment of duodenal variceal bleeding, because attempts at endoscopic varix ligation were unsuccessful. The post-operative course was uneventful and the patient was discharged without complications. A follow up CT scan obtained 21 mo after TIPS revealed a patent TIPS tract and complete obliteration of duodenal varices, but multinodular hepatocellular carcinoma had developed. He died of hepatic failure 28 mo after TIPS.

Successful treatment of giant rectal varices by modified percutaneous transhepatic obliteration with sclerosant:Report of a case

We present a female patient with continuous melena, diagnosed with rectal variceal bleeding. She had a history of esophageal varices, which were treated with endoscopic therapy. Five years after the treatment of esophageal varices, continuous melena occurred. Since colonoscopy showed that the melena was caused by giant rectal varices, we thought that they were not suitable to receive endoscopic treatment. We chose the modified percutaneous transhepatic obliteration with sclerosant, which is one of the interventional radiology techniques but a new clinical procedure for rectal varices. After the patient received this therapy, her condition of rectal varices was markedly improved.

Ectopic Ascending Colonic Variceal Bleeding Treated with Balloon-Occluded Retrograde Transvenous Obliteration in a Decompensated Liver Cirrhosis Patient—A Hepatology Perspective

Ectopic colonic varices development from liver cirrhosis and portal hypertension is uncommon. They are part of the spectrum of portal hypertensive colopathy. Colonic variceal bleeding remains a rare cause of lower gastrointestinal tract (GI) bleeding. Due to the paucity of cases, there are no well-established conventional treatments for bleeding colonic varices. Different treatments have been reported. Here, we report a case of a 55-year-old gentleman, with a history of alcoholic liver cirrhosis, presenting with severe lower GI bleeding and symptomatic anaemia. An esophagogastroduodenoscopy revealed large esophageal varices with high-risk bleeding stigmata requiring endoscopic variceal ligation. A cross-sectional computed tomography scan showed colonic portosystemic shunts. In light of this and that the severe lower GI bleeding seemed out of proportion to the esophageal varices seen on upper endoscopy, an urgent unprepped colonoscopy was performed which revealed possible bleeding diverticula disease which required endoscopic mechanical hemoclip therapy. However, despite this, patient had recurrence of lower GI bleeding prompting a second colonoscopy. This relook colonoscopy showed ectopic ascending colon varices with high-risk bleeding stigmata. High-dose intravenous vasoactive agent somatostatin (500 mcg/hour) and subsequently terlipressin (2 mg every 4 hours) were used. The patient subsequently underwent successful balloon-occluded retrograde transvenous obliteration (B-RTO) and sclerotherapy. The non-selective beta-blocker (NSBB) carvedilol was started and bridged together with the vasoactive agent until stabilisation of portal hypertension. This difficult case illustrates the dynamic nature of portal hypertensive bleeding. It also highlights the presence of confounding non-variceal pathology complicating diagnosis of portal hypertensive colonic variceal bleeding, and that ectopic ascending colonic variceal bleeding can be treated successfully with B-RTO and sclerotherapy, with meticulous titration of high-dose vasoactive agents and NSBB, in a decompensated alcoholic liver cirrhosis patient.

Balloon-occluded retrograde transvenous obliteration with lauromacrogol sclerosant foam for gastric varices

Objectives:To evaluate the safety and efficacy of balloon-occluded retrograde transvenous obliteration(BRTO)using lauromacrogol sclerosant foam for gastric varices(GVs)with gastrorenal venous shunts.Methods:Data of GV patients treated with BRTO using lauromacrogol sclerosant foam in 2016–2020 were retrospectively analyzed along with procedural success rate,complications,and follow-up efficacy.Results:A total of 31 patients were treated with BRTO.The sclerosant foam was prepared by mixing iodinated oil,lauromacrogol,and air at a 1:2:3 ratio.The BRTO procedure was successfully completed in 93.5%of patients.One patient was allergic to the lauromacrogol injection.A mild postoperative fever occurred in three patients.One patient experienced grand mal seizures after the procedure.There was no significant difference in the median Child-Turcotte-Pugh scores before versus after BRTO.Complete GV resolution was observed in 93.1%of patients.One patient underwent endoscopic treatment for the development of high-risk esophageal varices.Another patient underwent transjugular intrahepatic portosystemic shunt placement for the aggravation of ascites.Conclusions:Lauromacrogol sclerosant foam is safe and effective in patients undergoing BRTO for GV.

Postoperative surgical site infection in cholesteatoma surgery with and without mastoid obliteration, what can we learn?

Introduction:This study aims to describe the occurrence of postoperative complications related to cholesteatoma surgery and to determine factors influencing the most common complication,i.e.postoperative surgical site infection(SSI)in cases with and without mastoid obliteration.Materials and methods:Retrospective analyses were performed on surgically treated cholesteatomas in our hospital between 2013 and 2019.Patient characteristics,peri-and postoperative management and complications were reviewed.The cases were divided into two groups based on whether mastoid obliteration was performed or not.Results:A total of 336 cholesteatoma operations were performed,of which 248 cases received mastoid obliteration.In total 21 complications were observed,of which SSI was the most common(15/21).No difference in occurrence of any postoperative complication was seen between the obliteration and noobliteration group(p=0.798),especially not in the number of SSI(p=0.520).Perioperative and/or postoperative prophylactic antibiotics were not associated to the development of an SSI in both groups.In the no-obliteration group a younger age(p=0.015),as well as primary surgery(p=0.022)increased the risk for SSI.In the obliteration group the use of bioactive glass(BAG)S53P4 was identified as independent predictor of SSI(p=0.008,OR 5.940).Discussion:SSI is the most common postoperative complication in cholesteatoma surgery.The causes of SSI are multifactorial,therefore further prospective research is needed to answer which factors can prevent the development of an SSI in cholesteatoma surgery.

Usefulness of intra-procedural cone-beam computed tomography in modified balloon-occluded retrograde transvenous obliteration of gastric varices

AIM:To evaluate whether intra-procedural conebeam computed tomography(CBCT)performed during modified balloon-occluded retrograde transvenous obliteration(mB RTO)can accurately determine technical success of complete variceal obliteration.METHODS:From June 2012 to December 2014,15 patients who received CBCT during m BRTO for treatment of portal hypertensive gastric variceal bleeding were retrospectively evaluated.Three-dimensional(3D)CBCT images were performed and evaluated prior to the end of the procedure,and these were further analyzed and compared to the pre-procedure contrast-enhanced computed tomography to determine the technical success of m BRTO including:Complete occlusion/obliteration of:(1)gastrorenal shunt(GRS);(2)gastric varices;and(3)afferent feeding veins.Post-mB RTO contrast-enhanced CT was used to confirm the accuracy and diagnostic value of CBCT within 2-3 d.RESULTS:Intra-procedural 3D-CBCT images were 100% accurate in determining the technical success of m BRTO in all 15 cases.CBCT demonstrated complete occlusion/obliteration of GRS,gastric varices,collaterals and afferent feeding veins during m BRTO,which was confirmed with post-m BRTO CT.Two patients showed incomplete obliteration of gastric varices and feeding veins on CBCT,which therefore required additional gelfoam injections to complete the procedure.No patient required additional procedures or other interventions during their follow-up period(684 ± 279 d).CONCLUSION:CBCT during mB RTO appears to accurately and immediately determine the technical success of mB RTO.This may improve the technical and clinical success/outcome of m BRTO and reduce additional procedure time in the future.

“Axillary Space Obliteration”—An Effective Technique in Reducing Seroma Formation after Mastectomy and Axillary Dissection

Introduction: Seroma is the commonest complication of breast cancer surgery, and although its consequences most often cause no more than discomfort and anxiety, more important sequelae include flap necrosis and wound dehiscence. Seroma management can be difficult and frustrating for both the patient and surgeon. Numerous methods to reduce post-mastectomy seroma formation have been tried with no consistent success. Methods: Sixty patients were prepared for modified radical mastectomy. Of those, the study group contains 30 patients and the control group contains 30 patients. Study group had axillary space obliteration while the other had the conventional procedure;total drain outputs were recorded daily for all patients prior to drain removal. The drains were removed when the daily drainage was less than 30 ml. Results: This study contains 60 patients, and the study group contains 30 patients, and the control group contains 30 patients. Age, tumor size, No. of positive lymph nodes were of no significant differences to be more concise on the effect of axillary space obliteration. The mean of day of drain removal in the control group was 13.2 ± 1.0 days (9 - 18 days) with a mean of total drain output of (4700 ± 90.3 ml) (3722 - 4930) while the mean in the study group of day of drain removal was 7.1 ± 1.3 days (6 - 12) with a mean of total drain output of 1530 ± 422 ml (range 600 - 2100 ml) p < 0.001. Conclusion: Obliteration of axillary space is a valuable procedure that significantly decreases seroma after mastectomy and axillary dissection.

Coil-assisted retrograde transvenous obliteration for gastric varices in a Chinese case

Gastric varices are a major complication of portal hypertension in patients with liver cirrhosis and are associated with more massive bleeding events and higher mortality rate.Transjugular intrahepatic portosystemic shunt(TIPS)and balloon-occluded retrograde transvenous obliteration(BRTO)have been well documented as effective therapies for portal hypertensive gastric variceal bleeding.In China,TIPS are well accepted but BRTO is not well recieved due to the increase risk of complications associated with traditional BRTO.However,modified-BRTO,known as coil-assisted and plug-assisted retrograde transvenous obliteration(CARTO and PARTO,respectively),is receiving increased attention due to devoid of BRTO’s shortcomings.No CARTO case from China has been reported in literature thus far.Here,we present a Chinese case of CARTO to treat gastric varices bleeding.

血管内介入栓塞治疗脑动静脉畸形的疗效与影响因素

目的 探讨血管内介入栓塞治疗脑动静脉畸形(arteriovenous malformation,AVM)的疗效及影响因素。方法 回顾性分析41例接受血管内介入栓塞治疗的AVM病例资料,其中前循环供血26例,后循环供血6例,前后循环供血9例,单支供血动脉2例,合并动脉瘤18例,合并静脉球1例。结果 AVM即刻闭塞率为68.29%(28例),经分次栓塞后总的闭塞率为85.36%(35例),其中Spetzler-Martin分级Ⅰ~Ⅱ级患者完全闭塞23例、Ⅲ级4例、Ⅳ~Ⅴ级1例。治疗过程中出现出血并死亡1例,局部脑缺血1例。随访预后良好,即改良Rankin量表(modified Rankin scale,mRS)评分≤2分者39例(95.12%)。经卡方检验发现血管内介入栓塞治疗后的脑AVM闭塞情况与病灶直径有关(P=0.042)。结论 介入栓塞是脑AVM一种安全有效的治疗方法,病灶直径越小,完全闭塞率越高,效果越好。

超声内镜引导下置入弹簧圈联合组织胶注射治疗合并自发性分流的胃静脉曲张的效果分析

目的评估超声内镜(EUS)引导下置入弹簧圈联合组织胶注射(ECI)治疗合并自发性分流的胃静脉曲张的有效性、安全性和经济性。方法回顾性分析2019年3月—2022年9月因急性胃静脉曲张出血合并自发性门体分流在襄阳市中心医院住院并接受改良球囊封堵逆行静脉闭塞术(BRTO)联合内镜下ECI或EUS引导下置入弹簧圈联合ECI治疗的患者。统计分析两种手术方式的疗效(技术成功率,5天、1年再出血率,再出血时间)、安全性(异位栓塞发生率、组织胶用量、聚桂醇用量)和经济性(住院费用和时间)差异。符合正态分布的计量资料两组间比较采用成组t检验,不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验。采用Kaplan-Meier法对再出血情况进行评估和比较。计数资料两组间比较采用χ2检验。结果25例患者在EUS引导下成功放置弹簧圈并注射组织胶,技术成功率100%,中位组织胶用量为2.5 mL,中位聚桂醇用量为11.0 mL,平均住院时间为(14.88±3.21)d,平均住院费用为(32660.00±4602.07)元,5天再出血率为0;2例失访,23例完整随访患者中住院期间异位栓塞发生率为0,中位再出血时间为689 d。14例患者接受改良BRTO联合内镜下ECI,技术成功率100%,术中中位组织胶用量为5.0 mL,高于EUS组(U=39.000,P<0.001),中位聚桂醇用量为10.5 mL;平均住院时间为(15.38±4.94)d;平均住院费用为(57583.47±18955.40)元,高于EUS组(t=−6.310,P<0.001);5天再出血率为0;无失访,14例完整随访患者中住院期间异位栓塞发生率为0,中位再出血时间为244.50 d。Kaplan-Meier生存曲线分析表明,2组患者再出血风险无明显差异(χ^(2)=1.448,P=0.229)。结论EUS引导置入弹簧圈联合ECI是一种相对安全有效的胃静脉曲张出血治疗技术,技术成功率高,严重不良事件发生率低,疗效与BRTO手术无明显差异,但安全性和经济性更高。

球囊阻断逆行经静脉闭塞术治疗失代偿期肝硬化胃静脉曲张12例效果分析

目的 评价球囊阻断逆行经静脉闭塞术(BRTO)治疗失代偿期肝硬化胃静脉曲张(GV的临床效果。方法 回顾性分析2019年8月至2021年3月在昆明医科大学第二附属医院接受BRTO治疗的12例肝硬化GV患者临床资料。观察治疗前后静脉曲张栓塞效果,术后再出血率、肝功能变化及手术相关并发症。结果 12例患者BRTO手术均获成功。与手术前相比,术后患者总胆红素(TBil)明显降低[15.60(8.55,31.28)μmol/L比22.60(14.60,31.80)μmol/L,P=0.005],凝血酶原时间(PT)缩短[(15.57±2.14)s比(16.45±2.19)s,P=0.034];血清白蛋白(ALB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、谷氨酰转移酶(GGT)水平有所升高(均P>0.05);血清肌酐(Crea)、血小板(PLT)、凝血酶原时间(PT)、国际标准化比值(INR)水平有所下降(均P>0.05);Child-Pugh评分无明显变化,但终末期肝病模型(MELD)评分显著降低[(9.92±2.28)分比(10.92±2.91)分,P=0.002]。Kaplan-Meier分析显示,术后3、6、12个月累积再出血率分别为16.7%、25.9%、35.2%,术后12个月病死率为9.1%。结论 BRTO治疗GV可行、安全有效,可在止血的同时改善患者肝功能,但可能有食管静脉曲张和腹水加重风险,需进一步评估远期疗效。

右美托咪定静脉麻醉在急性前循环闭塞性卒中血管内治疗中的疗效及安全性

目的:探索右美托咪定静脉麻醉在急性前循环闭塞性卒中血管内治疗(EVT)中应用的疗效。方法:选择2019年6月至2021年6月厦门大学附属中山医院诊治的行EVT治疗的急性前循环闭塞性卒中患者116例,采用随机数字表法分为局部麻醉组(对照组)和局部麻醉联合术中右美托咪定静脉麻醉组(观察组)。比较2组患者疗效、并发症、S100-β及美国国立卫生院脑卒中量表(NIHSS)评分差异。结果:观察组血压波动发生率、穿刺到血管再通时间(PRT)、受线时间及取栓次数低于对照组(P<0.05),首次再通率高于对照组(P<0.05)。2组的血氧饱和度(SpO2)、肺部感染率、死亡率、总再通率及症状性颅内出血(SICH)的发生率差异无统计学意义(P>0.05)。2组术前及术后7 d的NIHSS评分均无统计学差异(P>0.05),但观察组术后7 d时NIHSS评分下降≥8分的患者比例显著高于对照组(P<0.05);2组术前S100-β水平差异无统计学差异(P>0.05),术后3d,观察组的S100-β水平低于对照组(P<0.05)。结论:右美托咪定应用于急性前循环闭塞性卒中EVT可提高疗效及降低神经功能损伤,具有高效安全等优点。