Gastroenterology Department II or Hepatology Center, The 2nd Affiliated Hospital of Kunming Medical University, Dianmian Avenue, No 374, Kunming City, Yunnan Province, 650101, China; Public Health Institute of Kunming Medical University, Kunming city, China.
Gastroenterology Department II or Hepatology Center, The 2nd Affiliated Hospital of Kunming Medical University, Dianmian Avenue, No 374, Kunming City, Yunnan Province, 650101, China.
Acad Radiol. 2018 Jul;25(7):925-934. doi: 10.1016/j.acra.2017.11.020. Epub 2018 Jan 17.
Transjugular intrahepatic portosystemic shunt (TIPS) is an established method for portal hypertension. This study was to investigate the long-term safety, technical success, and patency of TIPS, and to determine the risk factors and clinical impacts of shunt dysfunction.
A total of 154 consecutive patients undergoing embolotherapy of gastric coronary vein and/or short gastric vein and TIPS creation were prospectively studied. Follow-up data included technical success, patency and revision of TIPS, and overall survival of patients.
During the study, the primary and secondary technical success rates were 98.7% and 100%, respectively. Sixty-three patients developed shunt dysfunction, 30 with shunt stenosis and 33 with shunt occlusion. The cumulative 60-month primary, primary assisted, and secondary patency rates were 19.6%, 43.0%, and 93.4%, respectively. The cumulative 60-month overall survival rates were similar between the TIPS dysfunction group and the TIPS non-dysfunction group (68.6% vs. 58.6%, P = .096). Baseline portal vein thrombosis (P < .001), use of bare stents (P = .018), and portal pressure gradient (PPG) (P = .020) were independent predictors for shunt dysfunction, hepatocellular carcinoma (P < .001), and ascites (P = .003) for overall survival. The accuracy of PPG for shunt dysfunction was statistically significant (P < .001), and a cutoff value of 8.5 had 77.8% sensitivity and 64.8% specificity.
The long-term safety, technical success, and patency of TIPS were good; baseline portal vein thrombosis, use of bare stents, and PPG were significantly associated with shunt dysfunction; shunt dysfunction has little impact on patients' long-term survival because of high secondary patency rates.
经颈静脉肝内门体分流术（TIPS）是治疗门静脉高压的一种成熟方法。本研究旨在探讨 TIPS 的长期安全性、技术成功率和通畅率，并确定分流功能障碍的危险因素和临床影响。
前瞻性研究了 154 例接受胃冠状静脉和/或短胃静脉栓塞及 TIPS 术的连续患者。随访数据包括 TIPS 的技术成功率、通畅率和再通、患者的总生存率。
研究期间，主要和次要技术成功率分别为 98.7%和 100%。63 例患者出现分流功能障碍，其中 30 例为分流狭窄，33 例为分流闭塞。60 个月时的累积主要、主要辅助和次要通畅率分别为 19.6%、43.0%和 93.4%。TIPS 功能障碍组和 TIPS 非功能障碍组的 60 个月总生存率相似（68.6%比 58.6%，P = .096）。基线门静脉血栓形成（P < .001）、使用裸支架（P = .018）和门静脉压力梯度（PPG）（P = .020）是分流功能障碍的独立预测因素，肝癌（P < .001）和腹水（P = .003）是总生存率的独立预测因素。PPG 对分流功能障碍的准确性有统计学意义（P < .001），截断值为 8.5 时，灵敏度为 77.8%，特异性为 64.8%。
TIPS 的长期安全性、技术成功率和通畅率良好；基线门静脉血栓形成、使用裸支架和 PPG 与分流功能障碍显著相关；由于较高的二级通畅率，分流功能障碍对患者的长期生存影响不大。
