巨大門脈一大循環短絡路に対する塞栓療法一同時バルーン閉鎖下塞栓術の有用性一

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The feasibility and efficacy of embolization for the giant porto-systemic shunt (P-S shunt) were discussed and the usefullness of the dual balloon occluded embolotherapy (DBOE) were emphasized. In eight cases of giant P-S shunt (shunt diameter was more than 10mm on angiogram), 3 cases were performed by transcatheter and in 5 cases by DBOE. Liquid sclerosing agent (5% EO) and steel coils (coils) were used in 5 cases and only coils in 3 cases. The increasing rate of portal vein pressure after balloon occlusion was from 24.1% to 69.2% (average 35.7%). The rate relates to the complications of short term such as temporary ascites and worsening of esophageal varices. In all cases except one, improvement in the esophago-gastric varices was proved endoscopically. Disappearance rate of gastric varices in total cases was 71.4% but the rate was 100% in the cases of DBOE. The clinical symptoms disappeared in 2 patient with hepatoencephalopathy and 1 patient with ruptured gastric varices. During the clinical follow up period ranged from 1.5 months to 3 years and 1.5 months (average 1 year and 5.4 months), 1 patient died of rebleeding esophageal varices and hepatic failure. In conclusions, embolization with 5% EO and coils through dual balloon catheter provided a reliable and safe procedure for occlusion of giant P-S shunt. Indications for DBOE required two condition to be met; Child's classification A or B, and an increasing rate of PV-pressure of below 60% under preliminary balloon occlusion test.

巨大門脈一大循環短絡路に対する塞栓療法一同時バルーン閉鎖下塞栓術の有用性一

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