PDF(Pubmed)
Abstract：
BACKGROUND: Plug-assisted retrograde transvenous obliteration (PARTO) or coil-assisted retrograde transvenous obliteration (CARTO) are alternative treatments for gastric variceal bleeding and hepatic encephalopathy. Both procedures have fewer complications related to balloon rupture or sclerosing agents and are shorter than balloon-occluded retrograde transvenous obliteration. Herein, we report a case of PARTO and CARTO was performed simultaneously to treat refractory hepatic encephalopathy in a patient with 2 portosystemic shunts.
METHODS: A 59-year-old man with alcoholic liver cirrhosis presented to the emergency room with mental change. At presentation, the patient\'s plasma ammonia level was 340 μg/dL.
METHODS: A computed tomography scan revealed perisplenic collateral vessels and 2 splenorenal shunts.
METHODS: PARTO and CARTO were performed to treat hepatic encephalopathy via the 2 splenorenal shunts.
RESULTS: A follow-up computed tomography scan showed the splenorenal shunt was successfully embolized using a vascular plug and coil. After 3 weeks, the patient\'s plasma ammonia level decreased to 80 μg/dL, and repeated hospitalizations due to hepatic encephalopathy ceased.
CONCLUSIONS: Depending on the patient\'s anatomy, PARTO and CARTO can be performed simultaneously and, similar to balloon-occluded retrograde transvenous obliteration, are useful for treating hepatic encephalopathy.
METHODS: A 59-year-old man with alcoholic liver cirrhosis presented to the emergency room with mental change. At presentation, the patient\'s plasma ammonia level was 340 μg/dL.
METHODS: A computed tomography scan revealed perisplenic collateral vessels and 2 splenorenal shunts.
METHODS: PARTO and CARTO were performed to treat hepatic encephalopathy via the 2 splenorenal shunts.
RESULTS: A follow-up computed tomography scan showed the splenorenal shunt was successfully embolized using a vascular plug and coil. After 3 weeks, the patient\'s plasma ammonia level decreased to 80 μg/dL, and repeated hospitalizations due to hepatic encephalopathy ceased.
CONCLUSIONS: Depending on the patient\'s anatomy, PARTO and CARTO can be performed simultaneously and, similar to balloon-occluded retrograde transvenous obliteration, are useful for treating hepatic encephalopathy.
摘要：
背景：栓塞辅助逆行经静脉闭塞术（PARTO）或线圈辅助逆行经静脉闭塞术（CARTO）是胃静脉曲张破裂出血和肝性脑病的替代疗法。两种手术与球囊破裂或硬化剂相关的并发症较少，并且比球囊闭塞逆行经静脉闭塞更短。在这里，我们报告了1例PARTO和CARTO同时治疗2例门体分流的难治性肝性脑病.
方法：一名患有酒精性肝硬化的59岁男子因精神改变被送往急诊室。在介绍时,患者的血浆氨水平为340μg/dL。
方法：计算机断层扫描显示脾周侧支血管和2个脾肾分流。
方法：PARTO和CARTO通过2个脾肾分流治疗肝性脑病。
结果：随访计算机断层扫描显示，使用血管塞和线圈成功栓塞了脾肾分流。3周后,患者的血浆氨水平降至80μg/dL，因肝性脑病而反复住院的病例停止。
结论：根据患者的解剖结构，PARTO和CARTO可以同时执行，类似于球囊闭塞逆行经静脉闭塞，对治疗肝性脑病有用。
方法：一名患有酒精性肝硬化的59岁男子因精神改变被送往急诊室。在介绍时,患者的血浆氨水平为340μg/dL。
方法：计算机断层扫描显示脾周侧支血管和2个脾肾分流。
方法：PARTO和CARTO通过2个脾肾分流治疗肝性脑病。
结果：随访计算机断层扫描显示，使用血管塞和线圈成功栓塞了脾肾分流。3周后,患者的血浆氨水平降至80μg/dL，因肝性脑病而反复住院的病例停止。
结论：根据患者的解剖结构，PARTO和CARTO可以同时执行，类似于球囊闭塞逆行经静脉闭塞，对治疗肝性脑病有用。
