Zhang Yu, Liu Fu-Quan, Yue Zhen-Dong, Zhao Hong-Wei, Wang Lei, Fan Zhen-Hua, He Fu-Liang
Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, Beijing 100010, China.
World J Clin Cases. 2019 Jun 26;7(12):1410-1420. doi: 10.12998/wjcc.v7.i12.1410.
Transfemoral intrahepatic portosystemic shunt (TFIPS) can be performed to treat portal hypertension. However, few studies have evaluated the safety and efficacy of this technique.
To retrospectively evaluate the safety and clinical outcomes of TFIPS and compare them with those of typical transjugular intrahepatic portosystemic shunt (TIPS).
This retrospective study was approved by our hospital ethics committee. From November 2012 to November 2015, 19 patients who underwent successful TFIPS placement were included. In addition, 21 patients treated with TIPS during the same period were selected as controls. Data collected included the success rate and complications of TIPS and TFIPS. Continuous data were expressed as the mean ± SD and were compared using the Student's test. All categorical data were expressed as count (percentage) and were compared using the test or Fisher's exact test. The Kaplan-Meier method was used to calculate cumulative survival rate and survival curves.
Baseline characteristics were comparable between the two groups. The success rate of TFIPS and TIPS was 95% (19/20) and 100% (21/21), respectively. Effective portal decompression and free antegrade shunt flow was completed in all patients. The portal pressure gradient prior to TIPS and TFIPS placement was 23.91 ± 4.64 mmHg and 22.61 ± 5.39 mmHg, respectively, and it was significantly decreased to 10.85 ± 3.33 mmHg and 10.84 ± 3.33 mmHg after stent placement, respectively. Time-to-event calculated rates of shunt patency at one and two years in the TFIPS and TIPS groups were not statistically different (94.7% 95.2% and 94.7% 90.5%, respectively). hepatic encephalopathy was 27.5% (11/40) with five patients in the TFIPS group (26.3%) and six patients (28.6%) in the TIPS group experiencing it ( = 0.873). The cumulative survival rates were similar between the two groups: 94.7% and 94.7% at 1 and 2 years, respectively, in the TFIPS group 100% and 95.2% at 1 and 2 years, respectively, in the TIPS group ( = 0.942).
TFIPS may be a valuable adjunct to traditional approaches in patients with portal hypertension.
经股静脉肝内门体分流术（TFIPS）可用于治疗门静脉高压症。然而，很少有研究评估该技术的安全性和有效性。
回顾性评估TFIPS的安全性和临床结果，并与典型的经颈静脉肝内门体分流术（TIPS）进行比较。
本回顾性研究经我院伦理委员会批准。纳入2012年11月至2015年11月成功进行TFIPS置入的19例患者。此外，选择同期接受TIPS治疗的21例患者作为对照。收集的数据包括TIPS和TFIPS的成功率及并发症。连续数据以均数±标准差表示，采用Student's t检验进行比较。所有分类数据以计数（百分比）表示，采用χ²检验或Fisher精确检验进行比较。采用Kaplan-Meier法计算累积生存率和生存曲线。
两组基线特征具有可比性。TFIPS和TIPS的成功率分别为95%（19/20）和100%（21/21）。所有患者均完成了有效的门静脉减压和顺畅的顺行分流。TIPS和TFIPS置入前的门静脉压力梯度分别为23.91±4.64 mmHg和22.61±5.39 mmHg，置入支架后分别显著降至10.85±3.33 mmHg和10.84±3.33 mmHg。TFIPS组和TIPS组1年和2年的分流通畅率的事件发生时间计算率无统计学差异（分别为94.7%对95.2%和94.7%对90.5%）。肝性脑病发生率为27.5%（11/40），TFIPS组有5例患者（26.%)发生，TIPS组有6例患者（28.6%）发生（P = 0.873）。两组累积生存率相似：TFIPS组1年和2年分别为94.7%和94.7%，TIPS组1年和2年分别为100%和95.2%（P = 0.942）。
TFIPS可能是门静脉高压症患者传统治疗方法的一种有价值的辅助手段。
