特集名 | 門脈圧亢進症の治療update | |
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題名 | 門脈圧亢進症に対する外科治療とIVR (2) B-RTO | |
発刊年月 | 2012年 02月 | |
著者 | 松本 章夫 | 久御山南病院内科 |
【 要旨 】 | B-RTOは導入後20年を経過し,現在本邦においてはsplenorenal shuntを有する胃静脈瘤の第一選択の治療法あるいは門脈大循環シャントを有する難治性肝性脳症の治療法として定着している.しかし欧米における評価は満足のいくものではなく,その理由として硬化剤の安全性の問題や血液製剤の使用があげられる.大規模なprospective randomized studyで他の治療法に対する優位性を示すことが急務であるが,最近欧米でも一般的な硬化剤を用いて,少量の硬化剤で安全なB-RTOが施行可能であったとの報告があり,今後世界的に普及しうる可能性のある手法であると考えられる. |
Theme | Treatment for Portal Hypertension : Update | |
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Title | Management of Gastric Varices with Balloon-occluded Retrograde Transvenous Obliteration (B-RTO) | |
Author | Akio Matsumoto | Department of Internal Medicine, Kumiyama Minami Hospital |
[ Summary ] | It has been reported that esophageal varices rarely bleed when the portal pressure gradient (PPG) is < 12 mmHg. Transjugular intrahepatic portosystemic shunting (TIPS) is considered to be a second-line treatment for patients with gastroesophageal varices which are unresponsive to pharmacologic or endoscopic treatment. However, bleeding from gastric fundal varices (FV) can occur even when the PPG is < 12 mmHg. Several reports have shown that TIPS only improved mortality rates in patients with bleeding at PPG≥12 mmHg levels. Accordingly, decompressive procedures such as TIPS do not seem to provide much benefit for patients with FV who have major shunts and low PPG levels. B-RTO is similar to TIPS but less invasive, and is technically easy for interventional radiologists to perform. B-RTO is a recommended therapeutic option for treatment of patients with FV associated with splenorenal shunts, irrespective of PPG levels. |