Kerlan R K, LaBerge J M, Baker E L, Wack J P, Marx M, Somberg K A, Gordon R L, Ring E J
Department of Radiology, University of California at San Francisco 94115, USA.
J Vasc Interv Radiol. 1995 Nov-Dec;6(6):917-21. doi: 10.1016/s1051-0443(95)71212-x.
To establish a safe and effective method for occluding a transjugular intrahepatic portosystemic shunt (TIPS) in patients who develop uncontrollable, disabling encephalopathy.
The study population consisted of five patients who developed refractory encephalopathy following TIPS. The indication for TIPS was bleeding in four patients and ascites in one. Wallstents that were 10 mm in diameter and 68 mm long were used to bridge the hepatic parenchyma in all patients. The onset of encephalopathy from the time of the TIPS procedure ranged from 24 hours to 210 days. Because encephalopathy was not responsive to conventional medical management, shunt thrombosis was induced by means of temporary inflation of an 11.5-mm-diameter latex occlusion balloon within the midportion of the stent.
All shunts were successfully thrombosed when the balloon was inflated for 12 hours or more. Encephalopathy resolved in four patients and improved in the remaining patient. One patient experienced recurrent bleeding within 24 hours of the TIPS occlusion that was controlled medically.
Temporary occlusion of a TIPS with latex balloons successfully induces shunt thrombosis and improves encephalopathy. However, the patient is again exposed to risks related to complications of portal hypertension.
建立一种安全有效的方法，用于封堵发生难以控制的致残性肝性脑病的经颈静脉肝内门体分流术（TIPS）患者的分流通道。
研究人群包括5例TIPS术后发生难治性肝性脑病的患者。4例患者TIPS的指征为出血，1例为腹水。所有患者均使用直径10 mm、长68 mm的Wallstent支架桥接肝实质。从TIPS手术时起至肝性脑病发作的时间为24小时至210天。由于肝性脑病对传统药物治疗无反应，通过在支架中部暂时充盈直径11.5 mm的乳胶封堵球囊诱导分流道血栓形成。
当球囊充盈12小时或更长时间时，所有分流道均成功形成血栓。4例患者的肝性脑病得到缓解，其余1例患者病情改善。1例患者在TIPS封堵后24小时内出现复发性出血，经药物治疗得以控制。
用乳胶球囊临时封堵TIPS可成功诱导分流道血栓形成并改善肝性脑病。然而，患者再次面临与门静脉高压并发症相关的风险。
