Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan Province, China.
Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.9 Dongdansantiao, Dongcheng District,, Beijing, 100005, China.
J Gastrointest Surg. 2019 Nov;23(11):2193-2200. doi: 10.1007/s11605-019-04146-8. Epub 2019 Feb 21.
Uncontrolled variceal bleeding (VB) remains a great challenge for clinical treatment. Emergency transjugular intrahepatic portosystemic shunt (TIPS) is a salvage procedure, but unsatisfactory clinical outcomes and a high incidence of complications have been reported. This study aimed to investigate the effect and safety of emergency TIPS performed in our institution during recent years.
Fifty-eight consecutive cirrhotic patients with uncontrolled VB who underwent emergency TIPS from March 2009 to November 2017 in our hospital were followed until the last clinical evaluation, liver transplantation (LT), or death.
Overall, 5, 36, and 17 patients belonged to Child-Pugh class A, B, and C, respectively. TIPS was successfully performed in 57 (98.3%) patients at 89.5 h (mean) after initial bleeding. After TIPS, bleeding ceased in 52 (91.2%) patients, and 51 (89.5%) patients had a portal pressure gradient below 12 mmHg. Only one (1.8%) major procedure-related complication occurred without any clinical consequences, and no procedure-related deaths occurred. During follow-up, 55 hepatic encephalopathy (HE) episodes occurred in 19 (33.3%) patients, and the median time of the first HE episode was 3.1 months. Seven (12.3%) patients experienced shunt dysfunction after 8.7 months (median). The 6-week, 1-year, and 2-year variceal rebleeding rates were 10.5%, 17.1%, and 20.0%, respectively. The LT-free survival rates at 6 weeks, 1 year, and 2 years were 87.7%, 81.8% and 73.6%, respectively.
Our study highlights the fact that emergency TIPS could be effective for patients with liver cirrhosis and uncontrolled VB with few potential complications.
未控制的静脉曲张出血（VB）仍然是临床治疗的一大挑战。紧急经颈静脉肝内门体分流术（TIPS）是一种抢救性手术，但已有报道称其临床效果不理想且并发症发生率高。本研究旨在探讨我院近年来行紧急 TIPS 的效果和安全性。
回顾性分析 2009 年 3 月至 2017 年 11 月我院 58 例肝硬化合并未控制 VB 患者的临床资料，所有患者均行紧急 TIPS 治疗，随访至最后一次临床评估、肝移植（LT）或死亡。
58 例患者中，Child-Pugh 分级 A、B、C 级分别为 5 例、36 例、17 例。TIPS 于初次出血后 89.5 h（平均）内成功施行于 57 例（98.3%）患者。TIPS 后 52 例（91.2%）患者出血停止，51 例（89.5%）患者门静脉压力梯度＜12 mmHg。仅 1 例（1.8%）患者发生严重的手术相关并发症，但无临床后果，无手术相关死亡。随访期间，19 例（33.3%）患者发生 55 次肝性脑病（HE），首次 HE 发生时间的中位数为 3.1 个月。7 例（12.3%）患者在 8.7 个月后出现分流功能障碍。6 周、1 年和 2 年的静脉曲张再出血率分别为 10.5%、17.1%和 20.0%。6 周、1 年和 2 年的 LT 无失败生存率分别为 87.7%、81.8%和 73.6%。
本研究表明，对于肝硬化合并未控制 VB 的患者，紧急 TIPS 是一种有效的治疗方法，且潜在并发症少。
