Đánh giá kết quả bước đầu nút mạch xuyên gan qua da trong điều trị xuất huyết tiêu hóa do vỡ giãn tĩnh mạch dạ dày ở bệnh nhân xơ gan

Abstract

Upper gastrointestinal bleeding from gastroesophageal varices is a frequent complication in patients with liver cirrhosis and portal hypertension. Gastric varices are difficult to control under endoscopically while endovascular intervention is an effective method. Percutaneous transhepatic obliteration is one of the selected methods. In Vietnam, research data evaluating the results of this technique is limited, especially in patients with gastrorenal shunt. Therefore, we conducted a study  to evaluate the initial results of percutaneous transhepatic obliteration in the treatment of gastrointestinal bleeding due to gastric variceal rupture in patients with cirrhosis. The study was conducted on 34 patients with cirrhosis with gastrointestinal bleeding due to gastric variceal rupture from August 2023 to August 2024. The results showed that 91.1% of patients had good results after the intervention, with bleeding controlled during hospitalization. Common side effects were fever (17.6%) and abdominal pain in the intervention area (76.5%). There  was no serious complication related to the intervention such as uncontrolled puncture bleeding or systemic embolism. Prior to intervention, 82.4% of 17 patients had grade III gastric varices; this number decreased to 29.5% after intervention, which was a statistically significant difference with a confidence level of p=0.004. After 1 month, 3 months, and 6 months of follow-up, the  rates of  recurrence of bleeding  were 6.5%, 19.4%, and 25.8%, respectively. Thus, the simple PTO technique  has good results in initial control of gastrointestinal bleeding due to gastric  variceal rupture in patients with cirrhosis, however, the rate of rebleeding after hospital discharge is still elevated.