Department of Gastroenterology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
Department of Radiology, Air Force General Hospital of PLA, Haidian District, Beijing, 100142, China.
Biomed Res Int. 2018 Jun 13;2018:9804582. doi: 10.1155/2018/9804582. eCollection 2018.
We retrospectively identified 89 consecutive patients from January 2004 to January 2012 to investigate efficacy of direct intrahepatic portocaval shunt (DIPS) combined with inferior vena cava (IVC) stenting for sinusoidal obstruction syndrome (SOS) associated with hepatotoxicity of pyrrolizidine alkaloids. Indications for treatment were variceal hemorrhage and/or refractory ascites. Patients were treated with DIPS plus IVC stenting (group A, n=68) or DIPS alone (group B, n=21). A technical success rate of 100% was obtained in all 89 patients, and there were no early procedure-related adverse events or 30-day mortality. Mean portosystemic gradient decreased in both groups. Changes in aspartate and alanine aminotransferases and total bilirubin did not differ between the groups. Ascites disappeared in group A but was not obvious in group B until IVC stenting. During follow-up, recurrent bleeding and ascites and incidence of hepatic encephalopathy did not differ between the groups. The 1-, 3-, and 5-year survival rate was 98, 89.59, and 80%, respectively. Satisfactory clinical results were obtained for combined DIPS and IVC stenting for SOS associated with pyrrolizidine-alkaloid-related decompensated cirrhosis.
我们回顾性分析了 2004 年 1 月至 2012 年 1 月间 89 例连续患者，以研究直接肝内门体分流术（DIPS）联合下腔静脉（IVC）支架置入术治疗吡咯里西啶生物碱相关肝毒性所致窦状隙阻塞综合征（SOS）的疗效。治疗指征为静脉曲张出血和/或难治性腹水。患者接受 DIPS 联合 IVC 支架置入术（A 组，n=68）或 DIPS 单纯治疗（B 组，n=21）。89 例患者均获得 100%的技术成功率，且无早期与操作相关的不良事件或 30 天死亡率。两组患者的门体系统压力梯度均降低。两组患者的天冬氨酸转氨酶、丙氨酸转氨酶和总胆红素的变化无差异。A 组腹水消失，但 B 组直至 IVC 支架置入后腹水才消退。随访期间，两组患者的再出血和腹水发生率及肝性脑病发生率无差异。1、3、5 年生存率分别为 98%、89.59%和 80%。联合 DIPS 和 IVC 支架置入术治疗吡咯里西啶生物碱相关失代偿性肝硬化所致 SOS 可获得满意的临床效果。
