Lynn Amanda M, Singh Siddharth, Congly Stephen E, Khemani Disha, Johnson David H, Wiesner Russell H, Kamath Patrick S, Andrews James C, Leise Michael D
Internal Medicine.
Division of Gastroenterology, University of California, San Diego, La Jolla, CA.
Liver Transpl. 2016 Jun;22(6):723-31. doi: 10.1002/lt.24440.
Treatment options for refractory hepatic encephalopathy (HE) are limited. Patients who fail medical management may harbor large portosystemic shunts (PSSs) which are possible therapeutic targets. This study aims to describe patient selection, effectiveness, and safety of percutaneous PSS embolization in those with medically refractory HE. A retrospective evaluation of consecutive adult patients with medically refractory HE referred for PSS embolization at a tertiary center was performed (2003-2015). Patient data collected included the type of HE, medications, Model for End-Stage Liver Disease (MELD) score, shunt type, embolization approach, and materials used. Outcomes of interest were immediate (7 days), intermediate (1-4 months), and longer-term (6-12 months) effectiveness and periprocedural safety. Effectiveness was determined based on changes in hospitalization frequency, HE medications, and symptoms. Twenty-five patients with large PSS were evaluated for shunt embolization. Five were excluded due to high MELD scores (n = 1), comorbid conditions (n = 1), or technical considerations (n = 3). Of 20 patients who underwent embolization, 13 had persistent and 7 had recurrent HE; 100% (20/20) achieved immediate improvement. Durable benefit was achieved in 100% (18/18) and 92% (11/12) at 1-4 and 6-12 months, respectively. The majority (67%; 8/12) were free from HE-related hospitalizations over 1 year; 10% developed procedural complications, and all resolved. Six developed new or worsening ascites. In conclusion, PSS embolization is a safe and effective treatment strategy that should be considered for select patients with medically refractory HE. Liver Transplantation 22 723-731 2016 AASLD.
难治性肝性脑病（HE）的治疗选择有限。药物治疗无效的患者可能存在大的门体分流（PSS），这可能是治疗靶点。本研究旨在描述经皮PSS栓塞术在药物难治性HE患者中的患者选择、有效性和安全性。对一家三级中心连续收治的因药物难治性HE而接受PSS栓塞术的成年患者进行了回顾性评估（2003 - 2015年）。收集的患者数据包括HE类型、药物、终末期肝病模型（MELD）评分、分流类型、栓塞方法和使用的材料。关注的结果是即刻（7天）、中期（1 - 4个月）和长期（6 - 12个月）的有效性以及围手术期安全性。有效性根据住院频率、HE药物和症状的变化来确定。对25例有大PSS的患者进行了分流栓塞评估。5例因MELD评分高（n = 1）、合并症（n = 1）或技术因素（n = 3）被排除。在接受栓塞的20例患者中，13例有持续性HE，7例有复发性HE；100%（20/20）即刻改善。在1 - 4个月和6 - 12个月时，分别有100%（18/18）和92%（11/12）获得持久益处。大多数（67%；8/12）在1年以上无HE相关住院；10%发生手术并发症，且均已解决。6例出现新的或加重的腹水。总之，PSS栓塞术是一种安全有效的治疗策略，对于药物难治性HE的特定患者应予以考虑。《肝脏移植》22 723 - 731 2016美国肝病研究协会
