Jian-Ping Qin, Ming-De Jiang, Wen Tang, Xiao-Ling Wu, Xin Yao, Wei-Zheng Zeng, Hui Xu, Department of Digestion, Chengdu Military General Hospital, Chengdu 610083, Sichuan Province, China.
World J Gastroenterol. 2013 Nov 28;19(44):8085-92. doi: 10.3748/wjg.v19.i44.8085.
To determine the clinical effects and complications of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension due to cirrhosis.
Two hundred and eighty patients with portal hypertension due to cirrhosis who underwent TIPS were retrospectively evaluated. Portal trunk pressure was measured before and after surgery. The changes in hemodynamics and the condition of the stent were assessed by ultrasound and the esophageal and fundic veins observed endoscopically.
The success rate of TIPS was 99.3%. The portal trunk pressure was 26.8 ± 3.6 cmH2O after surgery and 46.5 ± 3.4 cmH2O before surgery (P < 0.01). The velocity of blood flow in the portal vein increased. The internal diameters of the portal and splenic veins were reduced. The short-term hemostasis rate was 100%. Esophageal varices disappeared completely in 68% of patients and were obviously reduced in 32%. Varices of the stomach fundus disappeared completely in 80% and were obviously reduced in 20% of patients. Ascites disappeared in 62%, were markedly reduced in 24%, but were still apparent in 14% of patients. The total effective rate of ascites reduction was 86%. Hydrothorax completely disappeared in 100% of patients. The incidence of post-operative stent stenosis was 24% at 12 mo and 34% at 24 mo. The incidence of post-operative hepatic encephalopathy was 12% at 3 mo, 17% at 6 mo and 19% at 12 mo. The incidence of post-operative recurrent hemorrhage was 9% at 12 mo, 19% at 24 mo and 35% at 36 mo. The cumulative survival rate was 86% at 12 mo, 81% at 24 mo, 75% at 36 mo, 57% at 48 mo and 45% at 60 mo.
TIPS can effectively lower portal hypertension due to cirrhosis. It is significantly effective for hemorrhage of the digestive tract due to rupture of esophageal and fundic veins and for ascites and hydrothorax caused by portal hypertension.
探讨经颈静脉肝内门体分流术（TIPS）治疗肝硬化门静脉高压症的临床效果及并发症。
回顾性分析 280 例肝硬化门静脉高压症患者 TIPS 治疗的临床资料。测量手术前后门静脉主干压力，通过超声和食管胃底静脉曲张内镜观察评估血液动力学变化和支架情况。
TIPS 成功率为 99.3%。术后门静脉主干压力为 26.8±3.6cmH2O，术前为 46.5±3.4cmH2O（P<0.01）。门静脉血流速度增加，门静脉、脾静脉内径缩小。近期止血率 100%，食管静脉曲张完全消失 68%，明显减轻 32%；胃底静脉曲张完全消失 80%，明显减轻 20%。腹水消失 62%，明显减少 24%，仍有 14%。腹水减少总有效率为 86%。胸水 100%完全消失。术后 12 个月和 24 个月支架狭窄发生率分别为 24%和 34%。术后肝性脑病发生率分别为 3 个月 12%、6 个月 17%和 12 个月 19%。术后再出血发生率分别为 12 个月 9%、24 个月 19%和 36 个月 35%。12 个月、24 个月、36 个月累积生存率分别为 86%、81%、75%、48 个月 57%和 60 个月 45%。
TIPS 可有效降低肝硬化门静脉高压症患者的门静脉压力，对于食管胃底静脉曲张破裂出血、门静脉高压引起的腹水和胸水具有显著疗效。
