Abstract：
Regarding the treatment for a portosystemic shunt, surgical or interventional radiological closure of the shunt was established. Interventional radiology including balloon-occluded retrograde transvenous obliteration can worsen portal hypertension and create a large thrombus close to the major venous system in the case of a huge portosystemic shunt. In contrast, it is also difficult to treat some cases through surgery alone when huge complicated shunts exist very deep in the body. Herein, we report a successful case of surgical shunt ligation for portosystemic encephalopathy in a hybrid operation room that enabled intraoperative angiography and computed tomography. A 62-year-old woman with chronic hepatitis C was referred to our hospital due to high levels of serum ammonia and hepatic encephalopathy. She had a massive, complicated portosystemic shunt from the inferior mesenteric vein to the left renal vein but did not have esophageal or gastric varices. It was difficult to occlude the portosystemic shunt by interventional radiologic techniques because the shunt had an extremely large amount of blood flow and many collateral routes. We performed the shunt ligation in the hybrid operation room. Intraoperative angiography provided detailed information about the portosystemic shunt, such as direction or volume of blood flow and collateral routes in real time. Her encephalopathy disappeared completely and she remains healthy with improved liver functional reserve to date. In conclusion, this is a successful case of a hybrid operation for an extremely large and complicated portosystemic shunt, providing for intraoperative angiography as a safe and reliable surgical treatment for portosystemic encephalopathy in patients with liver cirrhosis.
摘要：
关于门体分流术的治疗，建立了分流的外科或介入性放射封堵术。在巨大的门体分流的情况下，包括球囊闭塞的逆行经静脉闭塞的介入放射学会加剧门静脉高压，并在靠近主要静脉系统的情况下产生大的血栓。相比之下,当巨大的复杂分流器存在于人体深处时，仅通过手术治疗某些病例也很困难。在这里，我们报告了一例成功的手术分流结扎术治疗门体性脑病的病例,该病例是在混合手术室进行术中血管造影和计算机断层扫描的结果.一名62岁的慢性丙型肝炎妇女因血清氨水平高和肝性脑病而被转诊到我们医院。她有一个巨大的，复杂的门体分流从肠系膜下静脉到左肾静脉，但没有食管或胃静脉曲张。通过介入放射学技术很难阻塞门体分流，因为该分流具有非常大量的血流和许多侧支途径。我们在杂交手术室进行了分流结扎。术中血管造影提供了有关门体分流的详细信息，例如实时血流的方向或体积和侧支路径。她的脑病完全消失，至今仍保持健康，肝功能储备得到改善。总之,这是一个巨大而复杂的门体分流混合手术的成功案例，提供术中血管造影作为肝硬化门体脑病的安全可靠的手术治疗。
