Department of Gastroenterology, Nanjing Medical University Drum Tower Clinical Medical School.
Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
Eur J Gastroenterol Hepatol. 2019 Jul;31(7):853-858. doi: 10.1097/MEG.0000000000001349.
Transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention for portal hypertensive complications in cirrhosis. Spontaneous portosystemic shunts (SPSSs) may increase the risk of post-TIPS complications and mortality. This study was done to evaluate the safety and efficacy of TIPS for treating variceal bleeding between patients with and without SPSSs.
The clinical data of 467 consecutive patients with cirrhosis who received TIPS for variceal bleeding from January 2012 to January 2018 were screened. A total of 33 patients with coexisting SPSSs were included as the SPSS group, and 33 patients without SPSSs were randomly selected as control. The procedure-related complications and long-term outcomes were compared between the two groups.
Both groups were successfully treated with TIPS. SPSSs were antegradely embolized before TIPS placement. In terms of safety, one patient in the SPSS group experienced an asymptomatic pulmonary embolism, and another patient experienced serious gastric ulcer bleeding. Overall, 23 (70.0%) patients in the SPSS group and 16 (51.5%) patients in the control group experienced different mild complications (P=0.131). During a median follow-up of more than 2 years, the rebleeding rates (7.1 vs. 3.7% at 1 year, P=0.508), overt hepatic encephalopathy occurrence rates (34.4 vs. 39.4% at 2 years, P=0.685), and orthotopic liver transplantation-free survival rates (73.2 vs. 70.7% at 2 years, P=0.557) were not significantly different between the two groups.
TIPS combined with antegrade embolization is safe, effective, and feasible for patients with SPSSs, with safety and long-term outcomes comparable to patients without SPSSs.
经颈静脉肝内门体分流术（TIPS）是治疗肝硬化门静脉高压并发症的有效方法。自发性门体分流（SPSS）可能会增加 TIPS 术后并发症和死亡率的风险。本研究旨在评估 TIPS 治疗伴有和不伴有 SPSS 的肝硬化患者食管胃静脉曲张出血的安全性和疗效。
筛选了 2012 年 1 月至 2018 年 1 月期间因食管胃静脉曲张出血接受 TIPS 治疗的 467 例连续肝硬化患者的临床资料。共纳入 33 例伴有共存 SPSS 的患者作为 SPSS 组，随机选择 33 例无 SPSS 的患者作为对照组。比较两组患者的手术相关并发症和长期结局。
两组患者均成功接受 TIPS 治疗。SPSS 组在 TIPS 放置前进行了顺行栓塞。在安全性方面，SPSS 组 1 例患者无症状发生肺栓塞，另 1 例患者发生严重胃溃疡出血。总体而言，SPSS 组 23（70.0%）例患者和对照组 16（51.5%）例患者出现不同程度的轻度并发症（P=0.131）。在中位随访 2 年以上期间，再出血率（1 年时为 7.1%比 3.7%，P=0.508）、显性肝性脑病发生率（2 年时为 34.4%比 39.4%，P=0.685）和无原位肝移植生存率（2 年时为 73.2%比 70.7%，P=0.557）在两组间无显著差异。
TIPS 联合顺行栓塞术治疗伴有 SPSS 的患者安全、有效且可行，其安全性和长期结局与不伴有 SPSS 的患者相当。
