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经皮经肝曲张血管栓塞术治疗门体分流性脑病疗效分析
Efficacy of percutaneous transhepatic variceal embolization with 2-Octyl-cyanoacrylate in patients with severe recurrent hepatic encephalopathy
文章发布日期:2013年05月04日  来源:  作者:王广川,胡锦华,冯华,等  点击次数:3432次  下载次数:642次

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【摘要】:目的探讨经皮经肝TH胶栓塞治疗分流性脑病的临床疗效。方法经皮经肝门静脉穿刺插管,治疗12例反复发作的肝性脑病患者,将TH胶注射到门、体分流道内,使其永久闭塞。术后随访观察疗效。结果成功率100%(12/12)。术后门体压力梯度由(21.9±1.8)mm Hg升至(26.3±3.2)mm Hg,差异有统计学意义(P=0.00)。发热和腹痛是常见的并发症,发生率分别为500%(6/12)和41.7%(5/12);16.7%(2/12)患者出现可控制的腹水,未出现肝脏穿刺道出血、异位栓塞等严重并发症,无围手术期死亡病例。患者随访6~37个月,平均随访时间(22.7 ± 9.8)个月。所有患者肝性脑病症状都明显好转。在随访期间有250% (3/12) 患者肝性脑病复发,16.7% (2/12)患者出现上消化道出血,原因分别为食管静脉曲张破裂出血和门静脉高压性胃病出血,死亡2人(16.7%),死亡原因分别为肝功能衰竭和肝癌。结论经皮经肝曲张血管栓塞术在复发性分流性脑病的治疗中显示出了可靠的疗效和良好的安全性,值得推广研究。
【Abstract】:ObjectiveTo investigate the efficacy and safety of percutaneous transhepatic variceal embolization (PTVE) performed with 2-Octyl-cyanoacrylate (2-OCA) tissue adhesive for treating recurrent hepatic encephalopathy (HE) involving large portosystemic shunts. MethodsTwelve cirrhotic patients (8 males, 4 females; mean age: 62 years old) with recurrent HE (≥3 episodes/year, despite drug therapy) were treated by PTVE with 2-OCA. The surgery was performed under local anesthesia with B ultrasound- or X-ray-guided percutaneous needle injection of the adhesive into the hepatic portal vein with balloon dilation to occlude the portosystemic shunts. Preoperative and postoperative clinical and laboratory parameters, including HE episodes, with or without gastrointestinal bleeding, markers of liver and renal function and coagulation indicators, were recorded. Significance of surgery-induced change in portal vein pressure was assessed by paired t-test. ResultsThe PTVE was performed successfully in all 12 patients. The average injected volume of 2-OCA was 8.6 ml (range: 4-16 ml). The most frequent postoperative complications were pyrexia (6/12, 50.0%) and abdominal pain (5/12, 41.7%). The mean follow-up period was 22.7±9.8 months (range: 6-37 months). During the follow-up period, two patients (16.7%) developed transient ascites and two (16.7%) patients developed upper gastrointestinal bleeding (due to esophageal varices and portal hypertensive gastropathy, respectively). In addition, three patients (25.0%) experienced HE recurrence (at postoperative months 16, 19, and 30, respectively). Two patients (16.7%) died, one from progression of hepatic failure and the other from liver cancer. In general, the PTVE procedure significantly increased the portal pressure (preoperative: (21.9±1.8) mm Hg vs. postoperative: (26.3±3.2) mm Hg; P=000). ConclusionPTVE with 2-OCA is an effective and safe procedure for managing recurrent HE with large portosystemic shunts.
【关键字】:肝性脑病;栓塞,治疗性;门体分流术,外科
【Key words】:hepatic encephalopathy; embolization, therapeutic; portosystemic shunt, surgical
【引证本文】:

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