Qi Xingshun, Han Guohong
Fourth Military Medical University, Xijing Hospital of Digestive Diseases, 15 West Changle Road, Xi'an, 710032, China.
Hepatol Int. 2012 Jun;6(3):576-90. doi: 10.1007/s12072-011-9324-5. Epub 2011 Dec 1.
Reports of successful transjugular intrahepatic portosystemic shunt (TIPS) surgery in patients with portal vein thrombosis (PVT) are considered anecdotal owing to the technical difficulty of the procedure and potential procedure-related complications. A literature review was undertaken to determine the feasibility and safety of TIPS in the treatment of PVT. All studies in which TIPS was attempted in patients with PVT were identified by searching through the PUBMED and MEDLINE databases. A total of 424 PVT patients undergoing TIPS were reported in 54 articles. The success rate of TIPS insertion was 67-100% in 19 case series. Further, 85 patients with portal cavernoma underwent successful TIPS insertions. Three therapeutic strategies of TIPS placement were used: (1) TIPS placement followed by portal vein recanalization via the shunt, (2) portal vein recanalization via percutaneous approaches followed by TIPS placement, and (3) TIPS insertion between a hepatic vein and a large collateral vessel without portal vein recanalization. Four approaches were used to access the portal vein: transjugular, transhepatic, transsplenic, and transmesenteric. Intra-abdominal hemorrhage secondary to hepatic capsule perforation was lethal in only three patients. No episode of pulmonary embolism was reported. Other procedure-related complications were reversible. The overall incidence of shunt dysfunction and hepatic encephalopathy was 8-33% and 0-50%, respectively. In conclusion, the reviewed studies uniformly support the feasibility and safety of TIPS for PVT even in the presence of portal cavernoma. Further, several major issues that remain unresolved are discussed.
由于经颈静脉肝内门体分流术（TIPS）操作技术难度大以及存在潜在的与手术相关的并发症，门静脉血栓形成（PVT）患者成功进行TIPS手术的报道被认为是个案。进行了一项文献综述，以确定TIPS治疗PVT的可行性和安全性。通过检索PUBMED和MEDLINE数据库，确定了所有尝试对PVT患者进行TIPS的研究。54篇文章报道了总共424例接受TIPS的PVT患者。在19个病例系列中，TIPS置入成功率为67%-100%。此外，85例门静脉海绵样变性患者成功进行了TIPS置入。采用了三种TIPS放置治疗策略：（1）TIPS放置后通过分流道进行门静脉再通；（2）经皮途径进行门静脉再通后进行TIPS放置；（3）在肝静脉和大的侧支血管之间插入TIPS而不进行门静脉再通。采用了四种进入门静脉的方法：经颈静脉、经肝、经脾和经肠系膜。仅3例患者因肝包膜穿孔继发腹腔内出血死亡。未报告肺栓塞事件。其他与手术相关的并发症是可逆的。分流功能障碍和肝性脑病的总体发生率分别为8%-33%和0%-50%。总之，综述研究一致支持TIPS治疗PVT的可行性和安全性，即使存在门静脉海绵样变性。此外，还讨论了几个尚未解决的主要问题。
