Gazzera C, Righi D, Valle F, Ottobrelli A, Grosso M, Gandini G
Diagnostic and Interventional Radiology Institute, A.S.O. San Giovanni Battista, Via Genova 3, 10126, Turin, Italy.
Radiol Med. 2009 Feb;114(1):83-94. doi: 10.1007/s11547-008-0349-3. Epub 2008 Dec 11.
The authors present a retrospective analysis of a large series of patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement.
Between March 1992 and December 2006, 658 patients were referred to our centre for TIPS placement. Indications for the procedure were digestive tract bleeding (52.8%), refractory ascites (35.3%), preservation of portal vein patency prior to liver transplantation (3.0%) and thrombosis of the suprahepatic veins (2.3%). Other indications (6.6%) included pleural ascites, portal thrombosis and hepatorenal and hepatopulmonary syndromes. All patients were evaluated with colour Doppler ultrasonography and in a few cases with computed tomography. The portal system was punctured under sonographic guidance. Wallstent, Palmaz and Nitinol thermosensitive stents were used. Embolisation of persistent varices was performed in 6.8% of cases.
Technical success was 98.9%. During a 1,500-day follow-up, the cumulative incidence of stent revision was 25.7% (Nitinol), 32.9% (Wallstent) and 1.8% (Palmaz). Mortality rates were 31.1%, 38.5% and 56.4%, respectively. The technical complications included six cases of heart failure, six of haematobilia, three of stent migration, two of intrahepatic haematoma and one of haemoperitoneum. Eight patients with severe portosystemic encephalopathy (PSE) were treated with a reduction stent.
TIPS placement is safe and effective and may act as a bridge to liver transplantation. Ultrasonography plays a fundamental role in the preliminary assessment, in portal vein puncture and during the follow-up. Stent patency is satisfactory.
作者对大量接受经颈静脉肝内门体分流术（TIPS）的患者进行回顾性分析。
1992年3月至2006年12月期间，658例患者被转诊至本中心接受TIPS治疗。该手术的适应证包括消化道出血（52.8%）、难治性腹水（35.3%）、肝移植前保留门静脉通畅（3.0%）和肝上静脉血栓形成（2.3%）。其他适应证（6.6%）包括胸腔积液、门静脉血栓形成以及肝肾和肝肺综合征。所有患者均接受彩色多普勒超声检查，少数患者接受计算机断层扫描。在超声引导下穿刺门静脉系统。使用了Wallstent、Palmaz和镍钛诺热敏支架。6.8%的病例进行了持续性静脉曲张栓塞术。
技术成功率为98.9%。在1500天的随访期间，支架翻修的累积发生率分别为镍钛诺支架25.7%、Wallstent支架32.9%和Palmaz支架1.8%。死亡率分别为31.1%、38.5%和56.4%。技术并发症包括6例心力衰竭、6例胆道出血、3例支架移位、2例肝内血肿和1例腹腔积血。8例严重门体性脑病（PSE）患者接受了减容支架治疗。
TIPS治疗安全有效，可作为肝移植的桥梁。超声在初步评估、门静脉穿刺及随访过程中发挥着重要作用。支架通畅情况良好。
