Acute Pulmonary Edema Following Transjugular Intrahepatic Portosystemic Stent Shunt Creation in a Cirrhotic Patient: A Case Report

經頸靜脈肝內肝門靜脈造流術術後的急性肺水腫：一病例報告

林偉能(Wei-Neng Lin) ； 柯獻欽(Shian-Chin Ko) ； 陳志雄(Chih-Hsiung Chen) ； 楊煦星(Hsi-Hsing Yang) ； 鄭高珍(Kuo-Chen Cheng) ； 謝俊民(Jiunn-Min Shieh)

《胸腔醫學》 22卷4期 (2007/08) Pp. 259-264

https://doi.org/10.29806/TM.200708.0006

摘要

經頸靜脈肝內肝門靜脈造流術可以藉由降低門脈高壓，非常有效地控制危及生命的食道或是胃靜脈瘤出血和頑治性腹水，因此提高病人存活的機會。然而，就算造流術成功，術後分流功能正常，街後併發症卻很常見。這些不良作用主要是肝性腦病變、急性或是亞急性肝衰竭、嚴重敗血症，和技術上的併發症如急性阻塞、肝膽道穿孔、術式造成的腹內出血等。此外，因為肝硬化會出現心輸出量增加和週邊血管阻力下降，造成高血行動力學循環狀態，但造流術術後的肺部血行動力學改變卻很少受到注意。在本篇文章中，我們報導一名因為危急生命的靜脈瘤出血而住進加護病房的54歲男性病人，在病人接受經頸靜脈肝內肝門靜脈造流術之後，併發呼吸急促的問題，後來他被發現因為造流術術後產生的全身和肺部血行動力學改變後的急性肺水腫，在給予利尿劑治療後，呼吸喘的程度和胸部X光都有改善。然而，利尿劑治療對於造成支架內狹窄和病人長期預後的角色仍然不清楚。

關鍵字

急性肺水腫 ； 肝硬化 ； 經頸靜脈肝內肝門靜脈造流術

並列摘要

Through lowering portal hypertension, transjugular intrahepatic portosystemic stent shunt (TIPSS) can control life-threatening esophageal or gastric variceal bleeding and refractory ascites more effectively, and thereby provide a better chance of survival. Post-TIPSS complications, even in many patients with successfully functioning shunts, were reported to be mainly severe hepatic encephalopathy, acute or subacute hepatic failure, severe sepsis, and immediate technical complications such as acute occlusion, hepatobiliary perforation, and procedure-related intraabdominal bleeding. Herein, we report a 54-year-old man who was admitted to the medical intensive care unit due to life-threatening variceal hemorrhage. After he had undergone TIPSS, acute shortness of breath developed. He was found to have acute pulmonary edema possibly due to acute systemic and pulmonary hemodynamic change post-TIPSS. His dyspnea and lung condition in the chest radiograph improved after diuretics therapy. This is an uncommon complication post-TIPSS. The efficacy of diuretic therapy in in-stent stenosis and the long-term outcome remain unclear.

並列關鍵字

acute pulmonary edema ； liver cirrhosis ； transjugular intrahepatic portosystemic stent shunt