Stout L C, Lyon R E, Murray N G, Barth M H
Department of Pathology, University of Texas Medical Branch, Galveston.
Am J Gastroenterol. 1995 Jan;90(1):126-30.
The transjugular intrahepatic portosystemic shunt has recently become widely used for portal decompression. Shunt stenosis resulting from pseudointimal hyperplasia and hepatic encephalopathy are emerging as important midterm complications of the procedure. Bile extravasation caused by bile duct transection by the stent wires has been suggested as a cause of the pseudo-intimal hyperplasia. The present case report describes a 6 1/2-month-old transjugular intrahepatic portosystemic shunt in which apparent biliary epithelial proliferation had formed large cyst-like spaces within the pseudo-intima at the site of shunt stenosis. We hypothesize that secretory products from these biliary epithelial cells may have contributed to shunt stenosis by creating expansile cysts or by stimulating pseudointimal hyperplasia. In addition, we found a large, recent Zahn's infarct adjacent to the stent. Pseudointimal hyperplasia had extended from the stent wires into the orifices of contiguous small portal and hepatic vein branches. The resulting stenosis of these small veins may have contributed to the Zahn's infarct.
经颈静脉肝内门体分流术近来已广泛用于门脉减压。由假内膜增生导致的分流狭窄和肝性脑病正成为该手术重要的中期并发症。支架钢丝切断胆管引起的胆汁外渗被认为是假内膜增生的一个原因。本病例报告描述了一例6个半月大的经颈静脉肝内门体分流术，在分流狭窄部位的假内膜内，明显的胆管上皮增殖形成了大的囊肿样间隙。我们推测，这些胆管上皮细胞的分泌产物可能通过形成扩张性囊肿或刺激假内膜增生而导致分流狭窄。此外，我们在支架附近发现了一个近期形成的大的扎恩梗死灶。假内膜增生已从支架钢丝延伸至相邻小门静脉和肝静脉分支的开口处。这些小静脉由此产生的狭窄可能促成了扎恩梗死灶的形成。
