Vangeli Marcello, Patch David, Terreni Natalia, Tibballs John, Watkinson Anthony, Davies Neil, Burroughs Andrew Kenneth
Liver Transplantation and Hepatobiliary Unit, Royal Free Hospital and NHS Hampstead Trust, London, UK.
J Hepatol. 2004 Oct;41(4):560-6. doi: 10.1016/j.jhep.2004.06.024.
BACKGROUND/AIMS: Bleeding ectopic varices due to cirrhosis can be difficult to manage. We report our experience of uncontrolled bleeding from ectopic varices treated with transjugular intrahepatic porto-systemic shunt (TIPS).
We selected the 21 cirrhotics who underwent TIPS for bleeding ectopic varices from our database: Child-Pugh grade A (2), B (11) and C (8). Site of bleeding was rectal (11), colonic (2), ileal 1, jejunal 1, duodenal 1, and stomal (5).
TIPS was performed successfully in 19/21 (90%) patients. All except 1 had either a reduction in portosystemic pressure gradient < or = 12 mmHg (n=12) or reduction by 25-50% of baseline (n=6). TIPS alone was used in 12/19: 7 of these 12 had no further bleeding; 5 (42%) rebled within 48 h, and had embolisation, 4 without further bleeding. In 7 of 19, TIPS and embolisation were performed together: 2 patients (28%) rebled; further embolisation stopped the bleeding.
Ectopic varices do rebleed despite a reduction of porto-systemic pressure gradient < or = 12 mmHg or by 25-50% of baseline, following TIPS. Embolisation stopped bleeding in all but 1 patient. We recommend performing embolisation at the time of the initial TIPS to control bleeding from ectopic varices.
背景/目的：肝硬化引起的异位静脉曲张出血可能难以处理。我们报告经颈静脉肝内门体分流术（TIPS）治疗异位静脉曲张未控制出血的经验。
我们从数据库中选取21例因异位静脉曲张出血接受TIPS治疗的肝硬化患者：Child-Pugh分级A级（2例）、B级（11例）和C级（8例）。出血部位为直肠（11例）、结肠（2例）、回肠1例、空肠1例、十二指肠1例和吻合口（5例）。
19/21（90%）例患者TIPS操作成功。除1例患者外，所有患者的门体压力梯度均降低至≤12 mmHg（n = 12）或较基线降低25 - 50%（n = 6）。19例患者中12例仅接受了TIPS治疗：这12例中的7例未再出血；5例（42%）在48小时内再次出血，并接受了栓塞治疗，4例未再出血。19例中的7例同时进行了TIPS和栓塞治疗：2例患者（28%）再次出血；进一步栓塞止血。
尽管TIPS后门体压力梯度降低至≤12 mmHg或较基线降低25 - 50%，异位静脉曲张仍会再次出血。除1例患者外，栓塞治疗止住了所有患者的出血。我们建议在初次TIPS时同时进行栓塞治疗以控制异位静脉曲张出血。
