経皮経肝的門脈造影法について--経皮経肝的門脈造影より見た肝性脳症

概要

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In this study, the hemodynamics of the portal system and clinical findings were studied in patients with portal systemic encephalopathy but without hepatic failure. Seven cases of chronic recurrent encephalopathy (4 liver cirrhosis, 2 idiopathic portal hypertension, 1 Budd-Chiari syndrome) were examined and compared with twelve cases who had a gastro-renal shunt and/or splenorenal shunt but did not show encephalopathy as controls. The hemodynamic characteristics of portal systemic encephalopathy were: (1) blood of the superior mesenteric vein was flowing into systemic circulation, (2) the collateral channel was large and single, and (3) the portal vein and intrahepatic portal branches were narrow. The collateral channels were gastro-renal and/or spleno-renal shunts. There was no difference in portal vein pressure between the two groups. Esophageal varices were rare (one case) but gastric varices were often (three cases) in the encephalopathy group. There was no history of G.I. bleeding, and a history of ascites was elicited in only one case. High ICG retention, low molar ratio of amino acid (BCAA/AAA), and hyperammonemia following constipation were the characteristics of these seven cases. The total bilirubin, serum albumin and prothrombin time were not different from the control. The encephalopathy was well controlled by Lactulose or infusion of high concentrations of branched chain amino acid.
社団法人日本肝臓学会の論文