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Abstract：
This study aimed to assess the safety and efficacy of interventional embolization in cirrhotic patients with refractory hepatic encephalopathy (HE) associated with large spontaneous portosystemic shunts (SPSS). Inverse probability of treatment weighting (IPTW) was employed to minimize potential bias. A total of 123 patients were included in this study (34 in the embolization group and 89 in the control group). In the unadjusted cohort, the embolization group demonstrated significantly better liver function, a larger total area of SPSS, and a higher percentage of patients with serum ammonia levels > 60 µmol/L and the presence of hepatocellular carcinoma (HCC) (all P < 0.05). In the IPTW cohort, baseline characteristics were comparable between the two groups (all P > 0.05). Patients in the embolization group exhibited significantly longer HE-free survival compared to the control group in both the unadjusted and IPTW cohorts (both P < 0.05). Subsequent subgroup analyses indicated that patients with serum ammonia level > 60 μmol/L, hepatopetal flow within the portal trunk, the presence of solitary SPSS, a baseline HE grade of II, and the absence of HCC at baseline showed statistically significant benefit from embolization treatment (all P < 0.05). No early procedural complications were observed in the embolization group. The incidence of long-term postoperative complications was comparable to that in the control group (all P > 0.05). Hence, interventional embolization appears to be a safe and effective treatment modality for cirrhotic patients with refractory HE associated with large SPSS. However, the benefits of embolization were discernible only in a specific subset of patients.
摘要：
这项研究旨在评估肝硬化患者的安全性和有效性的介入栓塞与大量自发性门体分流（SPSS）相关的难治性肝性脑病（HE）。采用治疗加权的逆概率(IPTW)来最小化潜在偏差。本研究共纳入123例患者（栓塞组34例，对照组89例）。在未经调整的队列中，栓塞组表现出明显更好的肝功能，较大的SPSS总面积，血清氨水平>60µmol/L且存在肝细胞癌（HCC）的患者比例较高（均P<0.05）。在IPTW队列中，两组基线特征具有可比性(均P>0.05)。在未调整队列和IPTW队列中，与对照组相比，栓塞组患者的无HE生存期明显更长（均P<0.05）。随后的亚组分析表明，血清氨水平>60μmol/L的患者，门静脉主干内的肝血流，孤立的SPSS的存在，基线HE等级为II级，基线时未出现HCC，栓塞治疗具有统计学意义（均P<0.05）。栓塞组未出现早期手术并发症。术后远期并发症发生率与对照组相当(均P>0.05)。因此，对于伴有大SPSS的难治性HE的肝硬化患者，介入栓塞似乎是一种安全有效的治疗方式。然而,栓塞的益处仅在特定的患者亚组中可见.
