Department of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China.
Department of Radiology, Yuebei People's Hospital, Shaoguan, 512026, China.
Eur Radiol. 2018 Sep;28(9):3661-3668. doi: 10.1007/s00330-018-5360-z. Epub 2018 Mar 29.
The purpose of this study was to introduce a modified transjugular intrahepatic portosystemic shunt (TIPS), a percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS), and to evaluate its feasibility and efficacy in patients with variceal bleeding with chronic portal vein occlusion (CPVO) after splenectomy.
Twenty-four cirrhotic patients with CPVO after splenectomy who received PTIPS between 2010 and 2015 were included in this retrospective study. The indication was elective control of variceal bleeding. Success rates, effectiveness and complications were evaluated, with comparison of the pre- and post-portosystemic pressure gradient (PPG). Patients' clinical outcomes and shunt patency were followed periodically.
PTIPS was successfully placed in 22 patients (91.7%) and failed in two. The mean PPG fell from 22.0 ± 4.9 mmHg to 10.6 ± 1.6 mmHg after successful PTIPS (p < 0.05). No fatal procedural complications occurred. During the median follow-up of 29 months, shunt dysfunction occurred in five cases and hepatic encephalopathy in four cases. Three patients died because of rebleeding, hepatic failure and pulmonary disease, respectively. The other patients remained asymptomatic and the shunts patent.
We conclude that PTIPS, as a modified TIPS procedure with a high success rate, is safe and effective for variceal bleeding with CPVO after splenectomy.
• Portal vein occlusion used to be contraindication to transjugular intrahepatic portosystemic shunt. • Portal vein thrombosis is common in patients with previous splenectomy. • We developed a new method, percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS). • PTIPS is feasible in patients with portal vein thrombosis and splenectomy. • PTIPS is effective and safe for these kind of complicated portal hypertension.
本研究旨在介绍一种改良的经颈静脉肝内门体分流术（TIPS），即经皮经肝内门体分流术（PTIPS），并评估其在脾切除术后慢性门静脉闭塞（CPVO）合并食管静脉曲张出血患者中的可行性和疗效。
回顾性分析 2010 年至 2015 年期间接受 PTIPS 的 24 例 CPVO 合并脾切除术后肝硬化患者。适应证为择期控制食管静脉曲张出血。评估成功率、有效性和并发症，并比较门静脉系统压力梯度（PPG）前后变化。定期随访患者的临床转归和分流道通畅情况。
PTIPS 成功放置于 22 例患者（91.7%），2 例失败。成功的 PTIPS 后，平均 PPG 从 22.0±4.9mmHg 降至 10.6±1.6mmHg（p<0.05）。无致命性操作并发症发生。中位随访 29 个月期间，5 例出现分流道功能障碍，4 例出现肝性脑病。3 例患者分别因再出血、肝功能衰竭和肺部疾病死亡，其余患者无症状且分流道通畅。
我们认为，PTIPS 作为一种改良的 TIPS 术式，成功率高，对于脾切除术后 CPVO 合并食管静脉曲张出血患者是安全有效的。
门静脉闭塞曾经是经颈静脉肝内门体分流术的禁忌证。
脾切除术后患者门静脉血栓形成常见。
我们开发了一种新方法，即经皮经肝内门体分流术（PTIPS）。
PTIPS 对门静脉血栓形成和脾切除术后患者是可行的。
PTIPS 对这类复杂的门静脉高压症是有效且安全的。
