Saravanan Ramasamy, Nayar Manu, Gilmore Ian T, Smart Howard, McWilliams Richard G, Rowlands Peter C, Evans Jonathan, Murphy Mike, Gould Derek, Taylor Steve, Sutton Robert, Lombard Martin G
Department of Gastroenterology, Royal Liverpool & Broadgreen University Hospitals, UK.
Eur J Gastroenterol Hepatol. 2005 Nov;17(11):1165-71. doi: 10.1097/00042737-200511000-00003.
Transjugular intrahepatic portosystemic stent shunt (TIPSS) is now widely used in the treatment of uncontrolled and recurrent variceal haemorrhage. This study reports the outcome and long-term follow-up of 125 patients who were referred to a single centre for TIPSS.
One hundred and twenty-five patients were referred to undergo TIPSS. All but 10 had variceal haemorrhage. The 10 patients referred with refractory ascites were excluded from the analysis. Our follow-up protocol was to assess shunt patency only if bleeding recurred or there was a clinical indication. The mean age was 51.5 years (range 18-87 years) and 64 patients (56%) were male. The commonest aetiology for chronic liver disease was alcohol (80%). At referral, 19 patients (16%) were Child-Pugh class A, 26 patients (23%) were Child-Pugh class B and 70 patients (61%) were Child-Pugh class C. The mean follow-up period was 20.4 months (range 0-95 months).
TIPSS was successfully placed in 108 of 115 patients (94%). The thirty-day mortality was 30%. One-year and 2-year overall cumulative survival was 52% (survival ratio, 0.525; 95% confidence interval, 0.432-0.619) and 43% (survival ratio, 0.436; 95% confidence interval, 0.340-0.532), respectively.
TIPSS is effective in the treatment of uncontrolled or recurrent variceal bleeding. In comparison with previously published studies, our study suggests no value in regular or routine shunt surveillance to reduce rebleeding episodes or mortality, but this needs to be further assessed in prospective randomized studies.
经颈静脉肝内门体分流术（TIPSS）目前广泛应用于治疗难以控制的复发性静脉曲张出血。本研究报告了125例因TIPSS转诊至单一中心的患者的治疗结果及长期随访情况。
125例患者被转诊接受TIPSS治疗。除10例外，其余均有静脉曲张出血。10例因顽固性腹水转诊的患者被排除在分析之外。我们的随访方案是仅在出血复发或有临床指征时评估分流的通畅情况。平均年龄为51.5岁（范围18 - 87岁），64例患者（56%）为男性。慢性肝病最常见的病因是酒精（80%）。转诊时，19例患者（16%）为Child-Pugh A级，26例患者（23%）为Child-Pugh B级，70例患者（61%）为Child-Pugh C级。平均随访期为20.4个月（范围0 - 95个月）。
115例患者中有108例（94%）成功置入TIPSS。30天死亡率为30%。1年和2年的总体累积生存率分别为52%（生存比，0.525；95%置信区间，0.432 - 0.619）和43%（生存比，0.436；95%置信区间，0.340 - 0.532）。
TIPSS在治疗难以控制的或复发性静脉曲张出血方面有效。与先前发表的研究相比，我们的研究表明定期或常规监测分流以减少再出血发作或死亡率没有价值，但这需要在前瞻性随机研究中进一步评估。
