Ultrasonically-guided percutaneous transhepatic obliteration in the management of esophageal varices.

概要

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Ultrasonically-guided percutaneous transhepatic obliteration (PTO) was performed in 40 patients with gastro-esophageal varices for the management of variceal bleeding. Iso-butyl 2-cyanoacrylate, absolute alcohol and steel coil were used to make emboli in the collateral veins leading to the varices. Out of 40 patients, 29 had liver cirrhosis, 7 had liver cirrhosis with hepatocellular carcinoma, 2 had idiopathic portal hypertension and 2 had myelofibrosis. Fifty percent of the cases had severe liver dysfunction of Grade C (Child classification).In 94% of emergency cases, acute bleeding from varices was successfully terminated by PTO. A second episode of bleeding including gastric erosion after PTO accounted for 27% of the cases. Mortality rate was 25% except for 5 cases of hepatocellular carcinoma.According to a questionaire for the patients who underwent both PTO and endoscopic sclerotherapy, distress of PTO was comparable to that of endoscopic sclerotherapy.No serious complications requiring intensive care developed either during and after the procedure. PTO is an excellent, safe emergency treatment for variceal hemorrhage.
一般社団法人国立医療学会の論文