Rössle Martin, Olschewski Manfred, Siegerstetter Volker, Berger Elisabeth, Kurz Katharina, Grandt Daniel
Departments of Gastroenterology and Hepatology, the University Hospital of Freiburg, Hugstetterstrasse 55, D-79106 Freiburg, Germany.
Surgery. 2004 Apr;135(4):394-403. doi: 10.1016/j.surg.2003.09.005.
The role of portosystemic shunting in the treatment of the Budd-Chiari syndrome is still under debate. Medical therapy and liver transplantation are alternative treatments. The aim of this study was to determine the outcome of a transjugular intrahepatic portosystemic shunt implantation.
Thirty-five patients with severe Budd-Chiari syndrome and a Child-Pugh score of 9.2+/-1.9, who were not responsive to medical therapy, were elected for the transjugular shunt treatment, which was successfully accomplished in 33. Eleven patients had a fulminant/acute (history <2 months); 13, a subacute (<6 months); and 11, a chronic course of the disease. The shunt was established by using conventional self-expandable stents in 25 patients and polytetrafluoroethylene-covered stents in 8 patients. The mean follow-up was 37+/-29 months.
The shunt reduced the portosystemic pressure gradient from 29+/-7 to 10+/-4 mm Hg and improved the portal flow velocity from 9.2+/-11 to 51+/-17 cm/s. Clinical symptoms as well as the biochemical test results improved significantly during 4 weeks after shunt treatment. Three patients died and 2 received liver transplants. The cumulative 1- and 5-year survival rate without transplantation in all patients was 93% and 74%, respectively, and in patients with fulminant/acute disease 91% and 91% respectively (no deaths in this time period). On the average, 1.4+/-2.2 revisions per patient were needed during the mean follow-up of 3 years with a 1-year probability of 47%.
The transjugular shunt provides an excellent outcome in patients with severe fulminant/acute, subacute, and chronic Budd-Chiari syndrome. It may be regarded as a treatment for the acute and long-term management of these patients.
门体分流术在布加综合征治疗中的作用仍存在争议。药物治疗和肝移植是可供选择的治疗方法。本研究的目的是确定经颈静脉肝内门体分流术植入的效果。
选取35例严重布加综合征且Child-Pugh评分为9.2±1.9、对药物治疗无反应的患者进行经颈静脉分流治疗，其中33例成功完成。11例为暴发性/急性（病程<2个月）；13例为亚急性（<6个月）；11例为慢性病程。25例患者使用传统的自膨式支架建立分流，8例患者使用聚四氟乙烯覆膜支架。平均随访时间为37±29个月。
分流使门体压力梯度从29±7降至10±4 mmHg，并使门静脉血流速度从9.2±11提高到51±17 cm/s。分流治疗后4周内临床症状及生化检测结果显著改善。3例患者死亡，2例接受了肝移植。所有患者未进行移植的1年和5年累积生存率分别为93%和74%，暴发性/急性疾病患者分别为91%和91%（此时间段内无死亡）。在平均3年的随访期间，每位患者平均需要1.4±2.2次翻修，1年翻修概率为47%。
经颈静脉分流术在严重暴发性/急性、亚急性和慢性布加综合征患者中疗效良好。它可被视为这些患者急性和长期管理的一种治疗方法。
