Department of Gastroenterology, Provincial Hospital Affiliated to Shandong University, 324 Jingwu Weiqi Road, Jinan, 250021, Shandong, People's Republic of China,
Dig Dis Sci. 2014 Sep;59(9):2325-32. doi: 10.1007/s10620-014-3150-2. Epub 2014 Apr 19.
Transjugular intrahepatic portosystemic shunt (TIPS) with adjunctive embolotherapy has recently been reported to be effective in the prevention of variceal hemorrhage of cirrhotic patients. However, further investigation of its long-term efficacy is still needed.
To examine the rebleeding, survival, and hepatic encephalopathy (HE) after treatment with TIPS alone and TIPS with adjunctive embolotherapy using cyanoacrylate for esophageal variceal bleeding.
Patients with refractory to endoscopic therapy for esophageal variceal bleeding were enrolled. TIPS was performed in 101 patients with adjunctive embolotherapy (n = 53) or alone (n = 48) between January 2006 and December 2011. Chart reviews were performed to determine rebleeding, survival rates, and the incidence of HE.
Recurrent hemorrhage occurred in 12 (11.9 %) patients during the mean follow-up periods of 35.8 months. Rebleeding was observed in 9/48 (18.8 %) patients in TIPS alone group and 3/53 (5.7 %) patients in TIPS with adjunctive embolotherapy group (p = 0.042). Death occurred in 30 patients during follow-up (TIPS alone: n = 16, TIPS with adjunctive embolotherapy: n = 14, p = 0.447). Twenty-six episodes of HE occurred in 18 patients in TIPS alone group and 16 episodes occurred in 10 patients in TIPS with embolotherapy group. The probability of HE was significantly higher in TIPS alone group than in TIPS with embolotherapy group (p = 0.019).
TIPS with adjunctive embolotherapy with cyanoacrylate is relatively safe and effective, with a lower rebleeding and HE incidence in comparison of TIPS alone.
经颈静脉肝内门体分流术（TIPS）联合辅助栓塞治疗最近被报道可有效预防肝硬化患者的食管静脉曲张出血。然而，仍需要进一步研究其长期疗效。
检查 TIPS 单独治疗和 TIPS 联合氰基丙烯酸酯辅助栓塞治疗对食管静脉曲张出血的再出血、生存率和肝性脑病（HE）的影响。
纳入对内镜治疗无效的食管静脉曲张出血患者。2006 年 1 月至 2011 年 12 月，101 例患者接受 TIPS 治疗，其中 53 例接受辅助栓塞治疗（n=53），48 例仅接受 TIPS 治疗（n=48）。进行病历回顾以确定再出血、生存率和 HE 发生率。
在平均 35.8 个月的随访期间，有 12 例（11.9%）患者出现再出血。TIPS 单独组有 9/48（18.8%）例患者发生再出血，TIPS 联合辅助栓塞组有 3/53（5.7%）例患者发生再出血（p=0.042）。随访期间有 30 例患者死亡（TIPS 单独组：n=16，TIPS 联合辅助栓塞组：n=14，p=0.447）。TIPS 单独组有 18 例患者发生 26 次 HE，TIPS 联合栓塞组有 10 例患者发生 16 次 HE。TIPS 单独组 HE 的发生率明显高于 TIPS 联合栓塞组（p=0.019）。
TIPS 联合氰基丙烯酸酯辅助栓塞治疗相对安全有效，与 TIPS 单独治疗相比，再出血和 HE 的发生率较低。
