Namba Maiko, Kawaoka Tomokazu, Aikata Hiroshi, Kodama Kenichiro, Uchikawa Shinsuke, Ohya Kazuki, Morio Kei, Fujino Hatsue, Nakahara Takashi, Murakami Eisuke, Yamauchi Masami, Tsuge Masataka, Hiramatsu Akira, Imamura Michio, Baba Yasutaka, Awai Kazuo, Chayama Kazuaki
Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
Diagnostic Radiology, Institute, Graduate School of Biomedical Science, Hiroshima University Hospital, Hiroshima, Japan.
Clin J Gastroenterol. 2019 Aug;12(4):341-346. doi: 10.1007/s12328-019-00938-2. Epub 2019 Jan 31.
We report a 74-year-old male patient with compensated cirrhosis after hepatic C virus eradication. After the patient underwent hepatectomy for hepatocellular carcinoma, multiple lung and lymph node metastases were detected by computed tomography. Computed tomography also revealed a portosystemic shunt from the superior mesenteric vein to the right testicular vein. He was administered lenvatinib (12 mg). Five days after the initiation of lenvatinib, he developed grade 3 hepatic encephalopathy, and his ammonia level increased. Lenvatinib was stopped, with improvement of the encephalopathy and decrease in ammonia level. When lenvatinib was restarted, grade 2 encephalopathy recurred which then improved upon stopping the drug. We thought that the encephalopathy was due to the portosystemic shunt, and occlusion of the shunt was performed. The day after shunt occlusion, lenvatinib (8 mg) was restarted, and the lenvatinib dose was increased to 12 mg at 2 days after shunt occlusion. Subsequently, the ammonia level remained stable and the patient remained alert and conscious. Lenvatinib was continued until the time of this report (40 days after shunt occlusion), and after 1 month of lenvatinib therapy, the computed tomography verified absence of the portosystemic shunt and stable disease of hepatocellular carcinoma.
我们报告了一名74岁男性患者，其丙型肝炎病毒清除后出现代偿性肝硬化。该患者因肝细胞癌接受肝切除术后，计算机断层扫描检测到多处肺和淋巴结转移。计算机断层扫描还显示存在从肠系膜上静脉到右睾丸静脉的门体分流。给予其乐伐替尼（12毫克）治疗。乐伐替尼开始使用5天后，他出现3级肝性脑病，氨水平升高。停用乐伐替尼后，脑病得到改善，氨水平下降。当重新开始使用乐伐替尼时，2级脑病复发，再次停药后病情好转。我们认为脑病是由门体分流引起的，于是对分流进行了封堵。分流封堵术后第二天，重新开始使用乐伐替尼（8毫克），并在分流封堵术后2天将乐伐替尼剂量增加至12毫克。随后，氨水平保持稳定，患者保持警觉和清醒。乐伐替尼持续使用至本报告撰写时（分流封堵术后40天），乐伐替尼治疗1个月后，计算机断层扫描证实门体分流消失，肝细胞癌病情稳定。
