Transjugular intrahepatic portosystemic shunting improves splanchnic hemodynamics and renal Na excretion in cirrhosis with refractory ascites

International Hepatology Communications Pub Date : 1996-11-01 DOI:10.1016/S0928-4346(96)00319-2

Shuichi Sezai , Mitsuhiro Terada , Masayoshi Ito , Yukihiro Sakurai , Kazuaki Kamisaka , Takashi Abe , Fumiaki Ikegami , Masanori Hirano

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Abstract

To clarify the pathogenesis of ascites in patients with liver cirrhosis, we explored the effects of transjugular intrahepatic portosystemic shunting in six cirrhotic patients with refractory ascites. The portal pressure decreased from 39 ± 7 cmH₂O before treatment to 32 ± 5 cmH₂O immediately after the procedure. Liver function transiently deteriorated after the procedure, but recovered within 1 week. Urinary Na excretion increased 1 week after treatment. In five patients, ascites improved within 3 weeks. Along with the decrease of portal congestion, there was an improvement of esophageal varices, and an increase of gastric mucosal blood flow, and an inhibition of the renin-angiotensin-aldosterone system in all of the patients after 2–4 weeks. Manageable shunt encephalopathy occurred in three patients. These findings strongly suggest the pivotal role of increased portal pressure in the formation of ascites in patients with liver cirrhosis.

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经颈静脉肝内门静脉系统分流改善难治性腹水肝硬化患者内脏血流动力学和肾钠排泄

为了阐明肝硬化患者腹水的发病机制，我们探讨了经颈静脉肝内门体分流在6例肝硬化难治性腹水患者中的作用。门静脉压力由治疗前的39±7 cmH2O降至术后立即的32±5 cmH2O。术后肝功能短暂恶化，但在1周内恢复。治疗后1周尿钠排泄量增加。5例患者腹水在3周内改善。随着门静脉充血的减少，所有患者在2-4周后食管静脉曲张改善，胃黏膜血流量增加，肾素-血管紧张素-醛固酮系统抑制。3例患者发生可控制的分流性脑病。这些发现有力地提示了肝硬化患者腹水形成过程中门静脉压力增高的关键作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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International Hepatology Communications

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