Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain.
Department of Gastroenterology, Hepatology and Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain.
Gastroenterol Hepatol. 2021 Nov;44(9):620-627. doi: 10.1016/j.gastrohep.2020.10.018. Epub 2020 Nov 26.
Transjugular intrahepatic portosystemic shunts (TIPS) are successfully used in the management of portal hypertension (PH)-related complications. Debate surrounds the diameter of the dilation. The aim was to analyse the outcomes of and complications deriving from TIPS in patients with cirrhosis and identify predictors of survival.
This was a retrospective single-centre study, which included patients with cirrhosis who had a TIPS procedure for PH from 2009 to October 2018. Demographic, clinical and radiological data were collected. The Kaplan-Meier method was used to measure survival and predictors of survival were identified with the Cox regression model.
A total of 98 patients were included (78.6% male), mean age was 58.5 (SD±/-9.9) and the median MELD was 13.3 (IQR 9.5-16). The indications were refractory ascites (RA), variceal bleeding (VB) and hepatic hydrothorax (HH). Median survival was 72 months (RA 46.4, VB 68.5 and HH 64.7) and transplant-free survival was 26 months. Clinical and technical success rates were 70.5% and 92.9% respectively. Age (HR 1.05), clinical success (HR 0.33), sodium (HR 0.92), renal failure (HR 2.46) and albumin (HR 0.35) were predictors of survival. Hepatic encephalopathy occurred in 28.6% of patients and TIPS dysfunction occurred in 16.3%.
TIPS with 10-mm PTFE-covered stent is an effective and safe treatment for PH-related complications in patients with cirrhosis. Age, renal failure, sodium, albumin and clinical success are independent predictors of long-term survival.
经颈静脉肝内门体分流术（TIPS）成功用于治疗门静脉高压（PH）相关并发症。目前，对于扩张直径仍存在争议。本研究旨在分析 TIPS 治疗肝硬化患者 PH 相关并发症的结果和并发症，并确定生存的预测因素。
这是一项回顾性单中心研究，纳入了 2009 年至 2018 年 10 月期间因 PH 而行 TIPS 治疗的肝硬化患者。收集患者的人口统计学、临床和影像学数据。使用 Kaplan-Meier 法测量生存时间，并采用 Cox 回归模型确定生存的预测因素。
共纳入 98 例患者（78.6%为男性），平均年龄为 58.5（±9.9）岁，中位 MELD 为 13.3（9.5-16）。适应证为难治性腹水（RA）、静脉曲张出血（VB）和肝性胸水（HH）。中位生存时间为 72 个月（RA 为 46.4 个月，VB 为 68.5 个月，HH 为 64.7 个月），无移植生存时间为 26 个月。临床和技术成功率分别为 70.5%和 92.9%。年龄（HR 1.05）、临床成功（HR 0.33）、钠（HR 0.92）、肾衰竭（HR 2.46）和白蛋白（HR 0.35）是生存的预测因素。28.6%的患者发生肝性脑病，16.3%的患者发生 TIPS 功能障碍。
对于肝硬化患者 PH 相关并发症，10-mm PTFE 覆膜支架 TIPS 是一种有效且安全的治疗方法。年龄、肾衰竭、钠、白蛋白和临床成功是长期生存的独立预测因素。
