Hepatic Hemodynamic Laboratory, Liver Unit, Institut de Malalties Digestives i Metaboliques, University of Barcelona, Barcelona, Spain.
J Hepatol. 2013 Jan;58(1):45-50. doi: 10.1016/j.jhep.2012.08.020. Epub 2012 Aug 30.
BACKGROUND & AIMS: In a recent randomized international clinical trial (RCT) in high-risk cirrhotic patients with acute variceal bleeding, the early use of transjugular intrahepatic portosystemic shunt (TIPS) was associated with marked and significant reductions in both treatment failure and mortality. The aim of this study was to confirm these results in clinical practice in the same centers of the RCT study.
We retrospectively reviewed patients admitted for acute variceal bleeding and high risk of treatment failure (Child C <14 or Child B plus active bleeding), treated with early-TIPS (n=45) or drugs+endoscopic therapy (ET) (n=30).
Patients treated with early-TIPS had a much lower incidence of failure to control bleeding or rebleeding than patients receiving drug+ET (3 vs. 15; p <0.001). The 1-year actuarial probability of remaining free of this composite end point was 93% vs. 53% (p <0.001). The same was observed in mortality (1-year actuarial survival was 86% vs. 70% respectively; p=0.056). Actuarial curves of failure to control bleeding+rebleeding and of survival were well within the confidence intervals of those observed in the RCT.
This study supports the early use of TIPS in patients with cirrhosis and a high-risk variceal bleeding.
在最近一项高危肝硬化急性静脉曲张出血患者的随机国际临床试验（RCT）中，早期使用经颈静脉肝内门体分流术（TIPS）可显著降低治疗失败和死亡率。本研究旨在在 RCT 研究的相同中心的临床实践中证实这些结果。
我们回顾性分析了因急性静脉曲张出血和治疗失败高风险（Child-Pugh C <14 或 Child-Pugh B 合并活动性出血）而接受早期 TIPS（n=45）或药物+内镜治疗（ET）（n=30）治疗的患者。
与接受药物+ET 治疗的患者相比，早期 TIPS 治疗的患者控制出血或再出血的失败率要低得多（3% vs. 15%；p <0.001）。无复合终点的 1 年实际概率分别为 93%和 53%（p <0.001）。死亡率也观察到相同的结果（1 年实际生存率分别为 86%和 70%；p=0.056）。出血控制失败+再出血和生存的实际曲线在 RCT 观察到的置信区间内。
本研究支持在肝硬化和高危静脉曲张出血患者中早期使用 TIPS。
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