Riegler J L, Lang K A, Johnson S P, Westerman J H
Department of Medicine, Wilford Hall Medical Center, Lackland Air Force Base, Texas, USA.
Gastroenterology. 1995 Sep;109(3):978-83. doi: 10.1016/0016-5085(95)90409-3.
Hepatopulmonary syndrome is a complication of chronic liver disease in which arterial hypoxemia results from abnormalities in pulmonary blood flow. Severe hypoxemia can lead to clinical deterioration and death. Although the etiology is unknown, portal hypertension seems to be an important factor in the development of hepatopulmonary syndrome. No effective pharmacological therapy has been identified, but liver transplantation may be curative. Arterial hypoxemia may complicate transplant surgery, however, and resolution of the syndrome after liver transplantation is performed may be delayed. In addition, it seems that complete reversal of oxygenation abnormalities after liver transplantation is performed is unpredictable. We described a patient with hepatopulmonary syndrome who noted improvement in symptoms of dyspnea after the placement of a transjugular intrahepatic portosystemic shunt. Arterial oxygenation and calculated shunt fraction improved significantly during the follow-up period, and liver transplantation was subsequently performed without difficulty. Portal decompression using transjugular intrahepatic portosystemic shunt may represent a palliative therapy for hepatopulmonary syndrome in patients awaiting liver transplantation.
肝肺综合征是慢性肝病的一种并发症，其中动脉血氧不足是由肺血流异常导致的。严重的血氧不足可导致临床病情恶化和死亡。尽管病因不明，但门静脉高压似乎是肝肺综合征发展的一个重要因素。尚未确定有效的药物治疗方法，但肝移植可能治愈。然而，动脉血氧不足可能使移植手术复杂化，并且肝移植后该综合征的缓解可能会延迟。此外，肝移植后氧合异常的完全逆转似乎不可预测。我们描述了一名肝肺综合征患者，其在经颈静脉肝内门体分流术置入后呼吸困难症状有所改善。在随访期间，动脉氧合和计算得出的分流分数显著改善，随后顺利进行了肝移植。经颈静脉肝内门体分流术进行门静脉减压可能是等待肝移植患者肝肺综合征的一种姑息治疗方法。
