背景因素 术前准备适应症 名词和定义 历史 病理生理 知情同意书 BRTO技术上考虑 并发症 病例
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BRTO的适应症(2)

时间:2017-11-22 22:42来源:未知 作者:Mr.Editor 点击:
1) Technical success rate: 95.3% (success was defined as the disappearance or marked reduction of the varices after single or repeated B- RTO procedure[s].) 2) Hepaticencephalopathy: 12 out of 15pati


1) Technical success rate: 95.3% (success was defined as the disappearance or marked reduction of the varices after single or repeated B- RTO procedure[s].)

2) Hepaticencephalopathy: 12 out of 15patients (80%) showed improvement in the encephalopathy.

3) Approximately 36.5% of esophageal varices are aggravated, for which endoscopic treatment may be required. In the Lg- cf type, the gastric varices are thought to be worse in the route from the left gastric vein to the esophageal vein.

4) Changes in liver function: The increased portal blood flow improves the hepatic reserve. In this study, 45.3% (82/181 patients) showed an improvement in liver function. Liver volume increased in 91% of patients with average liver increase of 12.4%.

5) Porto- systemic encephalopathy through mesocaval shunt was treated by B- RTO, and success was gained in 86%. Clinically, 94.1% was successful.

6) Liver cancer, which is known to be a prognostic factor, was seen in 42 cases.
 
5. Complications:  Hematuria frequently appears, but it rarely leads to renal failure when haptoglobin is concomitantly used. Pulmonary embolism may occur, so balloon occlusion for long time is essential. Abdominal pain immediately after ethanol injection occurs very frequently, so analgesics are necessary.
 
6. Conclusions: B- RTO is used  to embolize the varices from downstream, in contrast to PTO, which embolizes the varices from upstream. B- RTO can be employed not only for gastric varices but also for duodenal varices and mesocaval shunt. Our results showed very excellent effects for gastric varices, suggesting the first choice of treatment for GV. In many cases, the portal blood flow becomes hepatopetal again, and half of the patients that underwent B- RTO showed a secondary effect of improvement in liver function, revealing that B- RTO has a therapeutic effect on liver cirrhosis.

 
References
1. Hirota S, Matsumoto S, Tomita M et. al. Retrograde Transvenous Obliteration of Gastric Varices. Radiology 1999; 211: 349-356.
2. Fukuda T, Hirota S, Sugimura K. Long- term results of balloon- occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy. J vasc Interv Radiol 12: 327-336, 2001.
3. Hirota S, Ichikawa S, Matsumoto S et. al. Interventional Radiologic Treatment for Idiopathic Portal Hypertension. Cardiovasc Intervent Radiol. 1999; 22: 311-314.
4. Fukuda T, Hirota S, Sugimoto K, Matsumoto S, Zamora CA, Sugimura K. “Downgrading” of gastric varices with multiple collateral veins in balloon- occluded retrograde transvenous obliteration. J Vasc Interv Radiol.2005 16(10):1379-83, 2005.
5. Hirota S, Kobayashi K, Maeda H, Yamamoto S, Nakao N. Balloon- occluded retrograde transvenous obliteration for portal hypertension, Radiation Medicine, in print.
6. Maeda H, Hirota S, Yamamoto S, Kobayashi K, Arai K, Miyamoto Y, Fukuda T, Sugimoto K, Nakao N. Outflow patterns of gastrointestinal shunts and collateral veins from gastric varices: Radiologic variations and relevance to balloon- occluded retrograde transvenous obliteration, CVIR, 2007 May- Jun;30(3):410-4.
 
Learning Objective
1. To learn how and when to do BRTO
2. To learn the technique of BRTO
3. To present recent trials and meta- analysis of the technique
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