Department of Digestive Surgery, Hepatobiliary Surgery and Liver Transplantation, University Hospital of Tours, CHU Tours, Avenue de la République, F37042, Tours, France.
FHU Support, F37000, Tours, France.
J Gastrointest Surg. 2019 Dec;23(12):2383-2390. doi: 10.1007/s11605-018-4053-x. Epub 2019 Feb 28.
Transjugular intrahepatic portosystemic shunt (TIPS) has been suggested to reduce portal hypertension-associated complications in cirrhotic patients undergoing abdominal surgery. The aim of this study was to compare postoperative outcome in cirrhotic patients with and without specific preoperative TIPS placement, following elective extrahepatic abdominal surgery.
Patients were retrospectively included from 2005 to 2016 in four centers. Patients who underwent preoperative TIPS (n = 66) were compared to cirrhotic control patients without TIPS (n = 68). Postoperative outcome was analyzed using propensity score with inverse probability of treatment weighting analysis.
Overall, colorectal surgery accounted for 54% of all surgical procedure. TIPS patients had a higher initial Child-Pugh score (6[5-12] vs. 6[5-9], p = 0.043) and received more beta-blockers (65% vs. 22%, p < 0.001). In TIPS group, 56 (85%) patients managed to undergo planned surgery. Preoperative TIPS was associated with less postoperative ascites (hazard ratio = 0.330 [0.140-0.780]). Severe postoperative complications (Clavien-Dindo > 2) and 90-day mortality were similar between TIPS and no-TIPS groups (18% vs. 23%, p = 0.392, and 7.5% vs. 7.8%, p = 0.644, respectively).
Preoperative TIPS placement yielded an 85% operability rate with satisfying postoperative outcomes. No significant differences were found between TIPS and no-TIPS groups in terms of severe postoperative complications and mortality, although TIPS patients probably had worse initial portal hypertension.
经颈静脉肝内门体分流术（TIPS）被认为可以降低接受腹部手术的肝硬化患者与门静脉高压相关的并发症。本研究旨在比较接受择期非肝脏腹部手术的肝硬化患者中，有和没有特定术前 TIPS 放置的术后结果。
从 2005 年至 2016 年，四个中心回顾性纳入患者。将接受术前 TIPS（n=66）的患者与无 TIPS 的肝硬化对照组患者（n=68）进行比较。使用逆概率治疗加权分析的倾向评分分析术后结果。
总体而言，结直肠手术占所有手术的 54%。TIPS 患者的初始 Child-Pugh 评分更高（6[5-12]比 6[5-9]，p=0.043），并且接受了更多的β受体阻滞剂（65%比 22%，p<0.001）。在 TIPS 组中，56（85%）名患者成功进行了计划手术。术前 TIPS 与术后腹水减少相关（风险比=0.330[0.140-0.780]）。TIPS 和无 TIPS 组之间严重术后并发症（Clavien-Dindo>2）和 90 天死亡率相似（18%比 23%，p=0.392，和 7.5%比 7.8%，p=0.644，分别）。
术前 TIPS 放置可使 85%的手术可操作性，且术后结果令人满意。在严重术后并发症和死亡率方面，TIPS 和无 TIPS 组之间没有发现显著差异，尽管 TIPS 患者可能存在更严重的初始门静脉高压。
