PDF(Pubmed)
Abstract：
UNASSIGNED: Embolization of large portosystemic shunts effectively controls gastric variceal bleeding and prevents hepatic encephalopathy. The significance of dynamic changes in hepatic venous pressure gradient before and after embolization on clinical events and patient outcomes remains unknown.
UNASSIGNED: In this retrospective single-center series, 46 patients with gastric variceal bleeding, hepatic encephalopathy, or both undergoing embolization (January 2018 to October 2020) were included, and dynamic changes in portal pressures were analyzed against patient outcomes.
UNASSIGNED: Males predominated. The most common portosystemic shunt syndrome was the lienorenal shunt. In all, 34 patients underwent embolization for hepatic encephalopathy and 11 for gastric variceal bleeding. The proportion of patients surviving at the end of 12 and 32 months was 86.96 and 54.35%, respectively. The hepatic venous pressure gradient before shunt embolization was 13.4 ± 3.2 and 16.9 ± 3.7 mm Hg after occlusion (p < 0.001). Bleeding from varices on overall follow-up was notable in five patients (10.9%), and overt hepatic encephalopathy in four (N = 42, 9.5%) patients at 6-12 months. The development of infections within 100 days and beyond the first year was associated with the risk of dying at the end of 12 and 32 months, respectively. Elevation of hepatic venous pressure gradient by >4 mm Hg from baseline and an absolute increase to >16 mm Hg immediately post-procedure significantly predicted the development of early- and late-onset ascites, respectively.
UNASSIGNED: Close monitoring for the development of infections and optimization of beta-blockers and diuretics after shunt embolization may improve clinical outcomes and help identify patients who will benefit from liver transplantation pending prospective validation.
UNASSIGNED: In this retrospective single-center series, 46 patients with gastric variceal bleeding, hepatic encephalopathy, or both undergoing embolization (January 2018 to October 2020) were included, and dynamic changes in portal pressures were analyzed against patient outcomes.
UNASSIGNED: Males predominated. The most common portosystemic shunt syndrome was the lienorenal shunt. In all, 34 patients underwent embolization for hepatic encephalopathy and 11 for gastric variceal bleeding. The proportion of patients surviving at the end of 12 and 32 months was 86.96 and 54.35%, respectively. The hepatic venous pressure gradient before shunt embolization was 13.4 ± 3.2 and 16.9 ± 3.7 mm Hg after occlusion (p < 0.001). Bleeding from varices on overall follow-up was notable in five patients (10.9%), and overt hepatic encephalopathy in four (N = 42, 9.5%) patients at 6-12 months. The development of infections within 100 days and beyond the first year was associated with the risk of dying at the end of 12 and 32 months, respectively. Elevation of hepatic venous pressure gradient by >4 mm Hg from baseline and an absolute increase to >16 mm Hg immediately post-procedure significantly predicted the development of early- and late-onset ascites, respectively.
UNASSIGNED: Close monitoring for the development of infections and optimization of beta-blockers and diuretics after shunt embolization may improve clinical outcomes and help identify patients who will benefit from liver transplantation pending prospective validation.
摘要：
■大门体分流栓塞可有效控制胃底静脉曲张出血并预防肝性脑病。栓塞前后肝静脉压力梯度的动态变化对临床事件和患者预后的意义仍然未知。
■在这个回顾性的单中心系列中，46例胃静脉曲张破裂出血，肝性脑病,或同时进行栓塞（2018年1月至2020年10月）包括在内，分析了门静脉压力的动态变化与患者预后的关系.
■男性占主导地位。最常见的门体分流综合征是肾上腺分流。总之,34例患者因肝性脑病接受栓塞治疗，11例患者因胃底静脉曲张出血接受栓塞治疗。12个月和32个月末存活的患者比例分别为86.96和54.35%,分别。分流栓塞前的肝静脉压力梯度为13.4±3.2和闭塞后的16.9±3.7mmHg（p<0.001）。5例患者（10.9%）在总体随访中出现静脉曲张出血，在6-12个月时，四名（N=42，9.5％）患者出现明显的肝性脑病。在100天内和第一年之后的感染发展与在12个月和32个月结束时死亡的风险有关，分别。肝静脉压力梯度从基线升高>4mmHg，术后立即绝对升高至>16mmHg，显着预测了早期和晚期腹水的发展。分别。
分流栓塞后密切监测感染的发展以及优化β受体阻滞剂和利尿剂可能会改善临床结局，并有助于确定哪些患者将从肝移植中受益，等待前瞻性验证。
■在这个回顾性的单中心系列中，46例胃静脉曲张破裂出血，肝性脑病,或同时进行栓塞（2018年1月至2020年10月）包括在内，分析了门静脉压力的动态变化与患者预后的关系.
■男性占主导地位。最常见的门体分流综合征是肾上腺分流。总之,34例患者因肝性脑病接受栓塞治疗，11例患者因胃底静脉曲张出血接受栓塞治疗。12个月和32个月末存活的患者比例分别为86.96和54.35%,分别。分流栓塞前的肝静脉压力梯度为13.4±3.2和闭塞后的16.9±3.7mmHg（p<0.001）。5例患者（10.9%）在总体随访中出现静脉曲张出血，在6-12个月时，四名（N=42，9.5％）患者出现明显的肝性脑病。在100天内和第一年之后的感染发展与在12个月和32个月结束时死亡的风险有关，分别。肝静脉压力梯度从基线升高>4mmHg，术后立即绝对升高至>16mmHg，显着预测了早期和晚期腹水的发展。分别。
分流栓塞后密切监测感染的发展以及优化β受体阻滞剂和利尿剂可能会改善临床结局，并有助于确定哪些患者将从肝移植中受益，等待前瞻性验证。
