可控弹簧圈限制TIPS分流道血流治疗难治性肝性脑病

Controllable spring coil limiting TIPS shunt blood flow in treatment of refractory hepatic encephalopathy

目的观察Interlock可控弹簧圈限制分流道血流对TIPS术后难治性肝性脑病的干预效果。方法对5例TIPS术后难治性肝性脑病患者以Interlock可控弹簧圈限制分流道血流,观察治疗效果。结果 5例共用7枚可控弹簧圈,其中10 mm×25 cm 3枚,15 mm×25 cm 1枚,10 mm×40 cm 3枚。限流术后配合内科对症治疗,1例患者明显好转,未出现肝性脑病症状;2例限流后2个月内仍反复发生肝性脑病,予以再次弹簧圈限流后症状消失;2例限流术后半个月出现腹胀、腹腔积液等门静脉高压症状,选用8 mm×60 mm球囊扩张原支架分流道处弹簧圈,植入8 mm×60 mm镍钛合金裸支架,之后未再出现肝性脑病及门静脉高压症状。结论以可控弹簧圈限制分流道血流治疗TIPS术后难治性肝性脑病(5例)安全可靠。

Objective To explore the effects of Interlock controllable spring coils for limiting blood flow of TIPS shunt in refractory hepatic encephalopathy patient after TIPS. Methods Interlock controllable spring coils were used to restrict shunt flow in 5 patients with refractory hepatic encephalopathy after TIPS operation. Results Totally 7 controllable spring coils were implanted in all 5 cases, including 3 coils of 10 mm×25 cm, 1 coil of 15 mm×25 cm and 3 coils of 10 mm×40 cm. Combined with symptomatic treatment after TIPS, the symptoms of hepatic encephalopathy were significantly improved in 1 patient, while in 2 patients recurrent hepatic encephalopathy symptoms were observed within 2 months after restriction and disappeared after the second restriction. In 2 patients with symptoms of portal vein hypertension 2 weeks after the first restriction, 8 mm×60 mm balloon was selected to expand the shunt channel, and then 8 mm×60 mm Nitinol alloy stent was implanted in each one, and no symptom of hepatic encephalopathy nor portal vein hypertension occurred after the stent implantation. Conclusion It is safe and reliable to treat refractory hepatic encephalopathy after TIPS(5 cases) with coils implantation for limiting blood flow.