Rosenqvist K, Sheikhi R, Nyman R, Rorsman F, Sangfelt P, Ebeling Barbier C
a Department of Radiology, Institution of Surgical Science, Uppsala University Hospital , Uppsala , Sweden.
b Department of Hepatology, Institution of Medical Science, Uppsala University Hospital , Uppsala , Sweden.
Scand J Gastroenterol. 2018 Jan;53(1):70-75. doi: 10.1080/00365521.2017.1386795. Epub 2017 Oct 9.
To evaluate transjugular intrahepatic portosystemic shunt (TIPS) in variceal bleeding in a clinical setting.
Retrospective review of 131 patients (116 with liver cirrhosis) treated with TIPS with covered stent grafts in a single centre from 2002 to 2016.
Survival at 1 and 2 years was 70% and 57% in patents with, and 100% at 2 years in patients without liver cirrhosis, respectively. A high Child-Pugh score and severe hepatic encephalopathy (HE) within 12 months post-TIPS were related to increased mortality. Re-bleeding occurred in 8% within 12 months and was related to TIPS dysfunction and a post-TIPS portosystemic gradient (PSG) of ≥5 mmHg. The main cause of TIPS dysfunction was that the stent did not fully reach the inferior vena cava. There was no correlation between the PSG and the occurrence of HE.
TIPS was safe and prevented re-bleeding in patients with variceal bleeding, with or without liver cirrhosis, regardless of Child-Pugh class and of how soon after bleeding onset, the TIPS procedure was performed. A post-TIPS PSG of ≥5 mmHg was associated with an increased risk for re-bleeding and there was no correlation between the post-TIPS PSG and the occurrence of HE.
在临床环境中评估经颈静脉肝内门体分流术（TIPS）治疗静脉曲张出血的效果。
回顾性分析2002年至2016年在单一中心接受带覆膜支架移植物的TIPS治疗的131例患者（116例肝硬化患者）。
肝硬化患者1年和2年生存率分别为70%和57%，非肝硬化患者2年生存率为100%。TIPS术后12个月内Child-Pugh评分高和严重肝性脑病（HE）与死亡率增加相关。12个月内8%的患者发生再出血，与TIPS功能障碍及TIPS后门体压力梯度（PSG）≥5 mmHg有关。TIPS功能障碍的主要原因是支架未完全到达下腔静脉。PSG与HE的发生无相关性。
TIPS安全有效，可预防静脉曲张出血患者（无论有无肝硬化）再出血，无论Child-Pugh分级如何，也无论出血发作后多久进行TIPS手术。TIPS后PSG≥5 mmHg与再出血风险增加相关，且TIPS后PSG与HE的发生无相关性。
