Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Stent Shunts. Potential Risk Factors and Its Prophylaxis / 介入放射学杂志

ABSTRACT

Purpose: To study the incidence of new or worsened hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic stent shunts (TIPSS) and to identify periprocedural factors influeneing patients at risk. Materials and methods: Between March 1993 and March 1997, 264 patients were treated with TIPSS. 212 patients were possible to assess the development of encephalopathy comprising the wholersome study data, 148 men and 64 women with age ranging from 18 to 74 years old. All patients underwent more than 3 months of clinical follow-up (3~45 months). 118 patients (55.66%) were categorized as Child's class A, 69 patients (52.55%) as Child's class B, 25 patients (11.75%) as Child's C. The diametes of the stent were 8mm im 41(18.87%) patients and 10 mm in 171(81.13%). We analyzed the following factors age, sex, Child's classification the degree of liver atrophy, TIPSS in emergency or not, and size, the curvature of the shunt tract, portacaval gradient (PCG) before and after TIPSS, embolization of the gactric varices, blood ammonia level, derection of portal vein flow detected with color Doppler imageng after shunt. Statistical methods were used with Student's test, X~2 test, rand sum tets, linear regression and correlation, and multeple limear regressin. Results: The overall incidence of nwe and worsened HE was 16.03% (33/212). Of these, 27 patients were claigced as minimal (grade Ⅰ) and 6 advanced (grade Ⅱ). By Child's classification, new or worsening HE was seen in 8.47% of class A, 11.59% of class B, 60.0% of class C. TIPSS- related HE was correlated to Child's classification (r=0.86). As regard to shunt siza, the HE rate of 8mm stent was 7.31% (3/41), 10mm stent was 17.54%(30/171), and the difference between the two groups wss statistically significance (P