Department of Interventional Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
World J Gastroenterol. 2012 Dec 21;18(47):7104-8. doi: 10.3748/wjg.v18.i47.7104.
We present a case with hepatic myelopathy (HM) due to a surgical splenorenal shunt that was successfully treated by endovascular interventional techniques. A 39-year-old man presented with progressive spastic paraparesis of his lower limbs 14 mo after a splenorenal shunt. A portal venogram identified a widened patent splenorenal shunt. We used an occlusion balloon catheter initially to occlude the shunt. Further monitoring of the patient revealed a decrease in his serum ammonia level and an improvement in leg strength. We then used an Amplatzer vascular plug (AVP) to enable closure of the shunt. During the follow up period of 7 mo, the patient experienced significant clinical improvement and normalization of blood ammonia, without any complications. Occlusion of a surgically created splenorenal shunt with AVP represents an alternative therapy to surgery or coil embolization that can help to relieve shunt-induced HM symptoms.
我们报告了一例肝性脊髓病（HM）病例，该病例由脾肾分流术引起，并通过血管内介入技术成功治疗。一名 39 岁男性在脾肾分流术后 14 个月出现进行性痉挛性截瘫。门静脉造影显示增宽的、通畅的脾肾分流。我们最初使用闭塞球囊导管来闭塞分流。进一步监测患者发现其血氨水平降低，下肢力量增强。然后我们使用 Amplatzer 血管塞（AVP）来实现分流的关闭。在 7 个月的随访期间，患者的临床症状显著改善，血氨水平恢复正常，无任何并发症。使用 AVP 闭塞手术创建的脾肾分流术是手术或线圈栓塞的替代治疗方法，可以帮助缓解分流引起的 HM 症状。
