Temmerman F, Laleman W, Maleux G, Nevens F
Department of Gastroenterology and Hepatology, University Hospitals KULeuven, Belgium.
Department of Radiology, University Hospitals KULeuven, Belgium.
Acta Gastroenterol Belg. 2020 Jan-Mar;83(1):67-71.
Patients with hepatic encephalopathy (HE) do not systematically receive priority on the waiting list for liver transplantation. In some patients with cirrhosis, excessive amounts of gut derived ammonia can bypass the liver parenchyma due to large spontaneous portosystemic shunts (SPSS) induced by portal hypertension. A similar but iatrogenic condition can occur after transjugular portosystemic shunt (TIPS) insertion. In these situations HE may develop and can become refractory to standard management. In patients with preserved liver function, embolization of large SPSS has been shown to control HE mostly without aggravation of other portal hypertensive complications. In case of post-TIPS HE endovascular shunt reduction is able to control refractory post-TIPS HE in the majority of the patients. New strategies to prevent post-TIPS, such as the use of controlled expansion endoprosthesis, are currently explored.
肝性脑病（HE）患者在肝移植等待名单上并非都能系统地获得优先排序。在一些肝硬化患者中，由于门静脉高压导致的大量自发性门体分流（SPSS），过量的肠道源性氨可绕过肝实质。经颈静脉肝内门体分流术（TIPS）置入后也可能出现类似但医源性的情况。在这些情况下，可能会发生HE，并且可能对标准治疗变得难治。在肝功能保留的患者中，已表明对大型SPSS进行栓塞大多能控制HE，而不会加重其他门静脉高压并发症。对于TIPS术后HE患者，血管内分流减少能够控制大多数患者难治性的TIPS术后HE。目前正在探索预防TIPS术后HE的新策略，例如使用可控扩张内支架。
