Ginès Pere, Uriz Juan, Calahorra Blas, Garcia-Tsao Guadalupe, Kamath Patrick S, Del Arbol Luis Ruiz, Planas Ramón, Bosch Jaime, Arroyo Vicente, Rodés Juan
Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), University of Barcelona, Instituto Reina Sofia de Investigación Nefrológica, Barcelona, Catalunya, Spain.
Gastroenterology. 2002 Dec;123(6):1839-47. doi: 10.1053/gast.2002.37073.
BACKGROUND & AIMS: The transjugular intrahepatic portosystemic shunt (TIPS) has been shown to be more effective than repeated paracentesis plus albumin in the control of refractory ascites. However, its effect on survival and healthcare costs is still uncertain.
Seventy patients with cirrhosis and refractory ascites were randomly assigned to TIPS (35 patients) or repeated paracentesis plus intravenous albumin (35 patients). The primary endpoint was survival without liver transplantation. Secondary endpoints were complications of cirrhosis and costs.
Twenty patients treated with TIPS and 18 treated with paracentesis died during the study period, whereas 7 patients in each group underwent liver transplantation (mean follow-up 282 +/- 43 vs. 325 +/- 61 days, respectively). The probability of survival without liver transplantation was 41% at 1 year and 26% at 2 years in the TIPS group, as compared with 35% and 30% in the paracentesis group (P = 0.51). In a multivariate analysis, only baseline blood urea nitrogen levels and Child-Pugh score were independently associated with survival. Recurrence of ascites and development of hepatorenal syndrome were lower in the TIPS group compared with the paracentesis group, whereas the frequency of severe hepatic encephalopathy was greater in the TIPS group. The calculated costs were higher in the TIPS group than in the paracentesis group.
In patients with refractory ascites, TIPS lowers the rate of ascites recurrence and the risk of developing hepatorenal syndrome. However, TIPS does not improve survival and is associated with an increased frequency of severe encephalopathy and higher costs compared with repeated paracentesis plus albumin.
经颈静脉肝内门体分流术（TIPS）在控制难治性腹水方面已被证明比反复穿刺放腹水加白蛋白更有效。然而，其对生存率和医疗费用的影响仍不确定。
70例肝硬化难治性腹水患者被随机分为TIPS组（35例）或反复穿刺放腹水加静脉输注白蛋白组（35例）。主要终点是无肝移植生存。次要终点是肝硬化并发症和费用。
在研究期间，TIPS组有20例患者死亡，穿刺放腹水组有18例患者死亡，而每组各有7例患者接受了肝移植（平均随访时间分别为282±43天和325±61天）。TIPS组1年时无肝移植生存概率为41%，2年时为26%，而穿刺放腹水组分别为35%和30%（P = 0.51）。多因素分析显示，仅基线血尿素氮水平和Child-Pugh评分与生存独立相关。与穿刺放腹水组相比，TIPS组腹水复发和肝肾综合征的发生率较低，而TIPS组严重肝性脑病的发生率较高。计算得出TIPS组的费用高于穿刺放腹水组。
对于难治性腹水患者，TIPS可降低腹水复发率和发生肝肾综合征的风险。然而，与反复穿刺放腹水加白蛋白相比，TIPS并不能提高生存率，且与严重脑病发生率增加及费用更高相关。
