Kimura M, Sato M, Kawai N, Tanihata H, Horihata K, Shioyama Y, Sonomura T, Yoshikawa A, Kishi K, Terada M, Yamada R
Department of Radiology, Wakayama Medical College.
Nihon Igaku Hoshasen Gakkai Zasshi. 1997 Apr;57(5):233-7.
TIPS (transjugular intrahepatic portosystemic shunt) is an efficacious treatment for esophagogastric varices, ascites and hypertensive gastrointestinal vasculopathy associated with portal hypertension. The main complication after the procedure is hepatic encephalopathy. We tried to elucidate the correlation between hepatic encephalopathy and changes in portal hemodynamics after TIPS, based on observation by Doppler ultrasonography. We carried out Doppler ultrasonography in 28 cases of TIPS to assess hepatopetal and hepatofugal blood flow in the right and left portal branches. Hepatic encephalopathy occurred after TIPS in 9 cases out of 28 (32%), and new onset of disease was observed in 6 of 9. Doppler ultrasonography revealed hepatofugal blood flow in both right and left portal branches in 6 cases, 5 of which showed encephalopathy. Hepatopetal blood flow of the right and left portal branches was observed in 17 of 28 cases after TIPS. Hepatic encephalopathy occurred in only 2 of 17 cases. The changes in portal vein hemodynamics after TIPS were investigated by color Doppler ultrasonography, which were considered to be very useful for prediction of hepatic encephalopathy and indication of medical treatment to prevent the occurrence of this disease.
经颈静脉肝内门体分流术（TIPS）是治疗食管胃静脉曲张、腹水以及与门静脉高压相关的高血压性胃肠血管病变的一种有效方法。该手术后的主要并发症是肝性脑病。我们试图基于多普勒超声检查的观察结果，阐明TIPS术后肝性脑病与门静脉血流动力学变化之间的相关性。我们对28例行TIPS的患者进行了多普勒超声检查，以评估左右门静脉分支的向肝血流和离肝血流。28例患者中有9例（32%）在TIPS术后发生了肝性脑病，其中6例为新发病例。多普勒超声检查显示，6例患者的左右门静脉分支均出现离肝血流，其中5例出现了脑病。TIPS术后28例中有17例观察到左右门静脉分支的向肝血流。17例中仅有2例发生肝性脑病。通过彩色多普勒超声检查对TIPS术后门静脉血流动力学变化进行了研究，其被认为对预测肝性脑病以及指导预防该疾病发生的药物治疗非常有用。
