Department of Medicine II, University Hospital Freiburg, Freiburg, Germany.
PraxisZentrum für Gastroenterologie und Endokrinologie, Freiburg, Germany.
Aliment Pharmacol Ther. 2016 Nov;44(10):1051-1061. doi: 10.1111/apt.13809. Epub 2016 Sep 27.
The implantation of a transjugular intrahepatic portosystemic shunt (TIPSS) is a complex angiographic procedure performed in patients with end-stage liver disease. Numerous case reports and narrative reviews have been published so far; however, studies systematically investigating procedural and shunt-related complications are lacking.
To systematically investigate complications and mortality occurring during the index hospital stay and the early (4-week) period after TIPSS implantation.
The study includes 389 patients who received a TIPSS implantation between 2004 and 2014. Data were obtained from the clinical records and technical reports of the TIPSS implantation.
During the index hospital stay, procedure-related complications occurred in 42 patients (10.8%) with intraperitoneal bleeding in 8 patients (2.1%) and infections in 14 patients (3.6%). Shunt- and disease-related complications consisted of hepatic encephalopathy (1-year incidence 29%), non-procedural infections (8.7%) and acute hepatic decompensation (4.1%). Nine patients (2.3%) died during the index hospital stay from procedure-related (two patients, 0.5%), shunt-related (four patients, 1%) or disease-related causes (three patients, 0.8%). 23 patients (5.9%) died during 4 weeks after TIPSS implantation. The 1-year probability of survival was 67.7% and was negatively associated with severe hepatic encephalopathy and acute hepatic decompensation.
Except hepatic encephalopathy, severe procedure- and shunt-related complications are rare and early mortality is low.
经颈静脉肝内门体分流术（TIPSS）的植入是在终末期肝病患者中进行的一种复杂的血管造影程序。迄今为止，已经发表了许多病例报告和叙述性综述；然而，缺乏系统研究程序和分流相关并发症的研究。
系统研究 TIPSS 植入术后住院期间和早期（4 周）发生的并发症和死亡率。
本研究纳入了 2004 年至 2014 年间接受 TIPSS 植入术的 389 名患者。数据来自 TIPSS 植入术的临床记录和技术报告。
在住院期间，42 名患者（10.8%）发生与手术相关的并发症，其中 8 名患者（2.1%）发生腹腔内出血，14 名患者（3.6%）发生感染。分流和疾病相关并发症包括肝性脑病（1 年发生率 29%）、非手术感染（8.7%）和急性肝功能失代偿（4.1%）。9 名患者（2.3%）在住院期间因手术相关（2 名患者，0.5%）、分流相关（4 名患者，1%）或疾病相关原因（3 名患者，0.8%）死亡。23 名患者（5.9%）在 TIPSS 植入后 4 周内死亡。1 年生存率为 67.7%，与严重肝性脑病和急性肝功能失代偿呈负相关。
除肝性脑病外，严重的手术和分流相关并发症罕见，早期死亡率低。
