Jentschura D, Storz L W, Rumstadt B, Winkler M
Chirurgische Universitätsklinik Mannheim.
Langenbecks Arch Chir. 1996;381(5):283-8. doi: 10.1007/BF00184050.
A total of 28 cirrhotic patients with porto-systemic anastomosis were compared with 38 cirrhotic patients without porto-systemic shunts concerning their mental state and biochemical parameters of importance for hepatic encephalopathy. A group of 37 metabolically healthy individuals provided the reference values for the psychometric test results and the EEG power spectra. Laboratory values for both groups showed marginal elevation of bilirubin, while the ammonia levels were significantly increased in the operated group. A significant difference was found concerning both the tyrosine level and that of the branched-chain amino acids. None of the patients who had surgical treatment showed clinical evidence of hepatic encephalopathy. Regarding the results in the flicker photometry, the non-shunted cirrhotic patients differed significantly from the healthy control subjects. For both the shunted and non-shunted cirrhotic patients, the results of the Viennese determination test and the number connection test indicated subclinical encephalopathy. We conclude that the elevated ammonia level in patients with porto-systemic anastomosis does not cause a significant mental disturbance. In well-selected patients, the porto-systemic end-side shunt is an appropriate procedure in the treatment of esophageal varices.
将28例患有门体分流的肝硬化患者与38例未进行门体分流的肝硬化患者在精神状态以及对肝性脑病具有重要意义的生化参数方面进行了比较。一组37名代谢健康的个体提供了心理测试结果和脑电图功率谱的参考值。两组的实验室值均显示胆红素略有升高，而手术组的氨水平显著升高。酪氨酸水平和支链氨基酸水平均存在显著差异。接受手术治疗的患者均未表现出肝性脑病的临床证据。关于闪烁光度法的结果，未分流的肝硬化患者与健康对照受试者有显著差异。对于分流和未分流的肝硬化患者，维也纳测定试验和数字连接试验的结果均表明存在亚临床脑病。我们得出结论，门体分流患者氨水平升高不会引起明显的精神障碍。在精心挑选的患者中，门体端侧分流术是治疗食管静脉曲张的合适方法。
