论文部分内容阅读
目的:报告5例经颈静脉途径肝内分流术(TIPSS)后肝性脊髓病(HM)的临床表现。资料和方法:5例均有乙型肝炎和静脉曲张破裂出血病史。TIPSS术前影像学检查显示肝萎缩明显,术后分流道通畅。曾做脊髓MR14例,1例做脊柱CT和脊髓造影。5例均行腰椎穿刺。结果:5例于TIPSS后4周～4个月出现进行性下肢痉挛性瘫痪,1例伴上肢无力,1例伴有尿失禁。5例术后有1次以上(1～6次)HE发作史。体检发现患者腱反射亢进,踝阵挛阳性,浅感觉正常,1例深感觉减退,除1例外,其余无明显肌萎缩表现。受累节段椎管影像学检查及腰椎穿刺脑脊液检查均无异常。5例均有术后持续高血氨及低蛋白血症。结论:TIPSS术后出现进行性下肢痉挛性瘫痪、不伴有感觉障碍者应考虑HM。与TIPSS相关HM的高危因素有术前明显肝萎缩、术后持续高血氨及肝性脑病。
OBJECTIVE: To report the clinical manifestations of hepatic myelopathy (HM) in 5 patients undergoing transjugular intrahepatic shunt (TIPSS). Materials and Methods: All 5 patients had history of hepatitis B and variceal bleeding. TIPSS preoperative imaging examination showed a significant hepatic collapse, postoperative shunt smooth. Had done spinal cord MR14 cases, 1 case of spinal CT and myelography. Five patients underwent lumbar puncture. Results: Five cases developed progressive lower extremity spastic paraplegia 4 weeks to 4 months after TIPSS, 1 case with upper extremity weakness and 1 case with urinary incontinence. 5 patients had more than one episode (1 ~ 6 times) HE episodes. Physical examination found that patients with tendon hyperreflexia, positive ankle clonus, shallow feeling normal, 1 case of deep feeling subsided, with 1 exception, the remaining no obvious muscle atrophy. The affected segment spinal canal imaging examination and lumbar puncture cerebrospinal fluid examination were normal. All the 5 patients had hypernatremia and hypoalbuminemia after operation. CONCLUSIONS: Progressive lower extremity spastic paralysis occurs after TIPSS, and HM should be considered in patients without sensory disturbances. High risk factors associated with TIPSS are preoperative liver atrophy, persistent high blood ammonia and hepatic encephalopathy.