Pateria Puraskar, Jeffrey Gary P, Garas George, Tibballs Jonathan, Ferguson John, Delriviere Luc, Huang Yi, Adams Leon A, MacQuillan Gerry
Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia, Australia.
J Med Imaging Radiat Oncol. 2017 Aug;61(4):441-447. doi: 10.1111/1754-9485.12563. Epub 2017 Jan 9.
Insertion of transjugular intrahepatic portosystemic shunt (TIPS) is an established therapeutic option to treat the complications of portal hypertension. The purpose of this study is to review the experience of a single Australian institute with TIPS and evaluation of result to emphasize the indication, aetiology of portal hypertension, prognostic factors, complications and survival. Use of TIPS as a bridge to liver transplantation was also analysed.
A retrospective cohort study of patients treated with TIPS at The Western Australian Liver Transplant Unit, Sir Charles Gairdner Hospital, over a period of 12 years. Kaplan-Meier method was used for survival analysis and cox-regression analysis was used to analyse the predictors of survival.
Fifty-three patients underwent TIPS between January 2000 and March 2012. The cumulative survival at 1 month, 1 year and 5 years was 90%, 70.9% and 43.9%, respectively. The predictors of survival were indication (variceal bleeding versus ascites, hazard ratio 3.19, CI 95%: 1.164-8.794, P = 0.024) and Model of End Stage Liver Disease score (Hazard ratio 2.513, CI 95%: 1.087-5.810, P = 0.031). Patients who underwent TIPS as a bridge to liver transplant had a 5-year survival of 71% that is comparable to the overall survival of Western Australian liver transplant unit.
Transjugular intrahepatic portosystemic shunt is a safe and effective method of treatment of complications of portal hypertension. TIPS can be safely used as a bridging therapy to liver transplant. Despite small number of TIPS being performed at our institute, our technical results are comparable to the institutes with bigger number of patients.
经颈静脉肝内门体分流术（TIPS）的植入是治疗门静脉高压并发症的一种既定治疗选择。本研究的目的是回顾澳大利亚一家机构开展TIPS的经验并评估结果，以强调门静脉高压的适应症、病因、预后因素、并发症和生存率。还分析了将TIPS用作肝移植桥梁的情况。
对在查尔斯·加德纳爵士医院西澳大利亚肝移植科接受TIPS治疗的患者进行为期12年的回顾性队列研究。采用Kaplan-Meier方法进行生存分析，采用Cox回归分析来分析生存预测因素。
2000年1月至2012年3月期间，53例患者接受了TIPS治疗。1个月、1年和5年的累积生存率分别为90%、70.9%和43.9%。生存预测因素为适应症（静脉曲张出血与腹水，风险比3.19，95%置信区间：1.164 - 8.794，P = 0.024）和终末期肝病模型评分（风险比2.513，95%置信区间：1.087 - 5.810，P = 0.031）。接受TIPS作为肝移植桥梁的患者5年生存率为71%，与西澳大利亚肝移植科的总体生存率相当。
经颈静脉肝内门体分流术是治疗门静脉高压并发症的一种安全有效的方法。TIPS可安全地用作肝移植的桥接治疗。尽管我们机构进行的TIPS数量较少，但我们的技术结果与患者数量较多的机构相当。
