ter Borg Pieter C J, Hollemans Mirjam, Van Buuren Henk R, Vleggaar Frank P, Groeneweg Michael, Hop Wim C J, Laméris Johan S
Department of Gastroenterology and Hepatology, Erasmus MC, Dr. Molewaterplein 40, Room Ca 326, 3015 GD Rotterdam, The Netherlands.
Radiology. 2004 May;231(2):537-45. doi: 10.1148/radiol.2312021797. Epub 2004 Mar 24.
To retrospectively assess the outcome of transjugular intrahepatic portosystemic shunt (TIPS) placement in a nonselected group of consecutive patients.
TIPS placement was attempted in 82 patients. Patients were followed up for at least 3 years according to a standard protocol that included repeated shunt evaluations. Fifty-four patients underwent TIPS placement for variceal bleeding, 24 for refractory ascites, and four for other indications. Recurrent bleeding, effect on ascites, long-term patency, development of encephalopathy, and survival and complication rates were evaluated with Kaplan-Meier survival analysis and Cox multivariate analysis.
TIPS placement was successful in 75 patients (91%). Mean follow-up lasted 29.4 months. Primary patency was 22% and 12%, primary-assisted patency was 67% and 46%, and secondary patency was 91% and 91% at 1- and 5-year follow-up, respectively. Nonalcoholic liver disease (P =.007) and increasing platelet counts (P =.006) independently predicted development of shunt insufficiency. The 1- and 5-year rates of recurrent variceal bleeding were 21% and 27%, respectively. In the majority of patients with refractory ascites, a beneficial effect of TIPS placement was observed. The risk for encephalopathy was 25% at 1-month follow-up and 52% at 3-year follow-up. The risk for chronic or severe intermittent encephalopathy was 15% at 1-year follow-up and 20% at 3-year follow-up. Serum creatinine levels (P =.001) and age (P =.02) were independent risk factors. Overall survival rate was 61%, 49%, and 42% at 1-, 3-, and 5-year follow-up, respectively. Age (P =.03), serum albumin level (P =.02), and serum creatinine level (P <.001) were independently related to mortality.
The risk for definitive loss of shunt function was 17% at 5-year follow-up, indicating that surveillance with shunt revision-when indicated-results in excellent long-term TIPS patency. TIPS placement effectively protects against recurrent bleeding.
回顾性评估在一组未经选择的连续患者中经颈静脉肝内门体分流术（TIPS）置入的结果。
对82例患者尝试进行TIPS置入。根据包括重复分流评估的标准方案对患者进行至少3年的随访。54例患者因静脉曲张出血接受TIPS置入，24例因难治性腹水接受TIPS置入，4例因其他指征接受TIPS置入。采用Kaplan-Meier生存分析和Cox多因素分析评估再出血、对腹水的影响、长期通畅率、肝性脑病的发生情况以及生存率和并发症发生率。
75例患者（91%）TIPS置入成功。平均随访时间为29.4个月。1年和5年随访时的初次通畅率分别为22%和12%，初次辅助通畅率分别为67%和46%，二次通畅率均为91%。非酒精性肝病（P = 0.007）和血小板计数增加（P = 0.006）独立预测分流功能不全的发生。静脉曲张再出血的1年和5年发生率分别为21%和27%。在大多数难治性腹水患者中，观察到TIPS置入有有益效果。随访1个月时肝性脑病风险为25%，3年时为52%。慢性或严重间歇性肝性脑病风险在1年随访时为15%，3年时为20%。血清肌酐水平（P = 0.001）和年龄（P = 0.02）是独立危险因素。1年、3年和5年随访时的总生存率分别为61%、49%和42%。年龄（P = 0.03）、血清白蛋白水平（P = 0.02）和血清肌酐水平（P < 0.001）与死亡率独立相关。
5年随访时分流功能最终丧失的风险为17%，这表明在有指征时进行分流修正监测可实现TIPS的优异长期通畅率。TIPS置入可有效预防再出血。
