Marquardt Steffen, Rodt Thomas, Rosenthal Herbert, Wacker Frank, Meyer Bernhard C
Department of Diagnostic and Interventional Radiology, Hanover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany,
Cardiovasc Intervent Radiol. 2015 Aug;38(4):903-12. doi: 10.1007/s00270-014-1035-6. Epub 2014 Dec 13.
To assess the impact of anatomical, procedural, and operator skill factors on the success and duration of fluoroscopy-guided transjugular intrahepatic portoystemic shunt following standard operating procedure (SOP).
During a 32-month period, 102 patients underwent transjugular intrahepatic portosystemic shunt creation (TIPS) by two interventional radiologists (IR) following our institutional SOP based on fluoroscopy guidance. Both demographic and procedural data were assessed. The duration of the intervention (D(Int)) and of the portal vein puncture (D(Punct)) was analyzed depending on the skill level of the IR as well as the anatomic or procedural factors.
In 99 of the 102 patients, successful TIPS without peri-procedural complications was performed. The mean D(Int) (IR1: 77 min; IR2: 51 min, P < 0.005) and the mean D(Punct) (IR1: 19 min; IR2: 13 min, P < 0.005) were significantly higher in TIPS performed by IR1 (with 2 years of clinical experience performing TIPS, n = 38) than by IR2 (>10 years of clinical experience performing TIPS, n = 61), (P < 0.005 both, Mann-Whitney U test). D Int showed a higher correlation with D(Punct) for IR2 (R(2) = 0.63) than for IR1 (R(2) = 0.13). There was no significant difference in the D(Punct )for both IRs with regard to the success of the wedged portography (P = 0.90), diameter of the portal vein (P = 0.60), central right portal vein length (P = 0.49), or liver function (MELD-Score before the TIPS procedure; P = 0.14).
TIPS following SOP is safe, fast, and reliable. The only significant factor for shorter D(Punct) and D(Int) was the clinical experience of the IR. Anatomic variability, successful portography, or liver function did not alter the duration or technical success of TIPS.
按照标准操作程序（SOP），评估解剖学、操作过程及术者技能因素对荧光透视引导下经颈静脉肝内门体分流术的成功率及透视时间的影响。
在32个月期间，两名介入放射科医生（IR）依据荧光透视引导，按照我们机构的SOP为102例患者实施了经颈静脉肝内门体分流术（TIPS）。对人口统计学数据和操作过程数据均进行了评估。根据介入放射科医生的技能水平以及解剖学或操作过程因素，分析了干预持续时间（D(Int)）和门静脉穿刺持续时间（D(Punct)）。
102例患者中有99例成功实施了TIPS，且未出现围手术期并发症。由临床经验2年的IR1（n = 38）实施的TIPS的平均D(Int)（IR1：77分钟；IR2：51分钟，P < 0.005）和平均D(Punct)（IR1：19分钟；IR2：13分钟，P < 0.005）显著高于临床经验超过10年的IR2（n = 61）（Mann-Whitney U检验，两者P均 < 0.005）。对于IR2，D Int与D(Punct)的相关性（R(2) = 0.63）高于IR1（R(2) = 0.13）。就楔形门静脉造影的成功率（P = 0.90）、门静脉直径（P = 0.60）、右门静脉中央长度（P = 0.49）或肝功能（TIPS手术前的终末期肝病模型评分；P = 0.14）而言，两位介入放射科医生的D(Punct)均无显著差异。
按照SOP实施的TIPS安全、快速且可靠。缩短D(Punct)和D(Int)的唯一显著因素是介入放射科医生的临床经验。解剖学变异、门静脉造影成功或肝功能并未改变TIPS的持续时间或技术成功率。
