Abstract
Objective To observe the efficacy of transjugular interventional therapy for patients with hepatic myelopathy after transjugular intrahepatic portosystemic shunt (TIPS). Methods Sixteen patients with hepatic myelopathy afte TIPS were treated with interventional therapy again.Four patients who were treated with drugs through shunt previously had poor prognosis,then the remaining 12 patients treated with current limited shunt had better prognosis,which were analyzed in this study.Activities of daily living were assessed by Barthel index,limb muscle strength scores were assessed by Lovette scoring system.The changes of liver function and portal vein pressure were analyzed by paired t-test,while other data such as serum ammonia level,Barthel index,Lovette scores before and after transjugular interventional therapy were compared by analysis of variance with repeated measurements. Results All the patients had no complication after operations.The liver function and portal vein pressure of 12 patients had no significan change before and after operation.Blood ammonia value were (77.9±17.9) mmol/L after TIPS,(77.9±14.8),(73.4± 21.5),(59.5±14.5),(52.0±16.5) mmol/L 1,3,6,12 months after current limited shunt.Compared with that of preoperation (F=6.45,P<0.05),it decreased significantly at the 6th and 12th month.Limb muscle strength scores were 2.1±0.7 before current limited shunt,2.3±0.8,3.1±1.0,3.2±1.1,2.8±0.9 1,3,6,12 months after the operation.Compared with preoperation (F=4.97,P<0.05),muscle strength grading improved significantly at the 3rd,6th and 12th month.Activities of daily living Barthel index were 42.1±10.5 before current limited shunt,47.1±11.0,45.0±8.8 3,6 months after the operation.Compared with preoperation (F=5.05,P<0.05),activities of daily living had improvement.There were 3,6,2,1 cases of hepatic encephalopathy ofⅠ,Ⅱ,Ⅲ,Ⅳstage after TIPS.Three months after current limited shunt there were 7,3,1,0 cases,while there were 8,1,1,0 cases 6 months after the operation.In other 4 patients treated with drugs,2 patients died of liver failure,one was lost to follow. Conclusions Interventional therapy can relieve symptoms of hepatic myelopathy.The operation is safe,effective,and helpful after TIPS treatment. Key words: Liver cirrhosis; Spinal cord diseases; Portasystemic shunt,transjugular intrahepatic; Radiology,interventional; Treatment outcome
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