Kato T, Uematsu T, Nishigaki Y, Sugihara J, Tomita E, Moriwaki H
First Department of Internal Medicine, Gifu University School of Medicine.
Intern Med. 2001 Aug;40(8):688-91. doi: 10.2169/internalmedicine.40.688.
Balloon-occluded retrograde transvenous obliteration (B-RTO) has recently been introduced as a new interventional modality to prevent fatal bleeding from solitary gastric varices. A large portal-systemic shunt including gastric varices also causes severe encephalopathy in some cirrhotic patients. In this study, we evaluated the effect of B-RTO as a candidate therapeutic method to treat chronic recurrent hepatic encephalopathy due mainly to a portal-systemic shunt.
Since July 1995, we experienced 43 cirrhotic patients with chronic reccurent hepatic encephalopathy. Among them, six patients had anigographically proven large (>1 cm in diameter) portal-systemic shunt, and received B-RTO. B-RTO was carried out only once using 5% ethanolamine oleate with iopamidole to obliterate the portal-systemic shunt for 30 minutes. The median observation period after B-RTO was 29 months (range 23-46 months).
In all 6 patients, encephalopathy had disappeared after B-RTO, and the patients were free of encephalopathy during the following 6 months. B-RTO significantly reduced blood ammonia levels at one month, 3 months, and 6 months later, without affecting serum aspartate aminotransferase activity, total bilirubin and albumin concentrations, and plasma prothrombin time. Encephalopathy relapsed in 4 patients between 6 and 30 months. Additional B-RTO was required and effective in 2 of them.
B-RTO is an effective treatment for chronic recurrent hepatic encephalopathy with an angiographically proven portal-systemic shunt.
球囊闭塞逆行静脉栓塞术（B-RTO）最近作为一种新的介入方式被引入，用于预防孤立性胃静脉曲张导致的致命性出血。包括胃静脉曲张在内的大的门体分流在一些肝硬化患者中也会引起严重的肝性脑病。在本研究中，我们评估了B-RTO作为一种候选治疗方法治疗主要由门体分流引起的慢性复发性肝性脑病的效果。
自1995年7月以来，我们收治了43例慢性复发性肝性脑病的肝硬化患者。其中，6例经血管造影证实存在大的（直径>1 cm）门体分流，并接受了B-RTO治疗。仅使用5%油酸乙醇胺和碘帕醇进行一次B-RTO，闭塞门体分流30分钟。B-RTO后的中位观察期为29个月（范围23 - 46个月）。
所有6例患者在B-RTO后肝性脑病均消失，且在随后的6个月内未再出现肝性脑病。B-RTO在1个月、3个月和6个月后显著降低了血氨水平，而不影响血清天冬氨酸转氨酶活性、总胆红素和白蛋白浓度以及血浆凝血酶原时间。4例患者在6至30个月之间肝性脑病复发。其中2例需要再次进行B-RTO且治疗有效。
对于经血管造影证实存在门体分流的慢性复发性肝性脑病，B-RTO是一种有效的治疗方法。
