Zhang Lijie, Li Qing, Makamure Joyman, Zhao Dan, Liu Ziyi, Zheng Chuansheng, Liang Bin
Department of Radiology, Hubei Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China.
BMC Gastroenterol. 2021 Jan 10;21(1):26. doi: 10.1186/s12876-021-01599-7.
To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) on hepatic sinusoidal obstruction syndrome (HSOS) associated with consumption of Gynura segetum (GS).
We retrospectively reviewed 9 consecutive patients with GS-related HSOS who were refractory to supportive treatment and underwent TIPS at our institution between January 2014 and September 2019. The patients were evaluated for safety and efficacy, including TIPS complications and changes in portosystemic pressure gradient (PPG), ascites, total bilirubin, liver size and portal vein diameter.
TIPS procedures were performed successfully in the 9 patients, and no technically-related complications due to the TIPS procedure were recorded. The PPG was improved by TIPS in all patients (mean PPG before TIPS, 30.4 ± 5.2 vs. 13.0 ± 4.1 mm Hg post-TIPS, P = 0.008). One patient who was lost to follow-up, whereas the remaining 8 patients survived with a median follow-up period of 12 months (range 5-39 months). Although the total bilirubin was significantly increased 5-7 days after TIPS compared with that before the procedure (3.57 ± 1.58 vs. 4.82 ± 2.06 mg/dl, P = 0.017), it returned to baseline levels at 1-month follow-up (3.53 ± 2.72 vs. 4.82 ± 2.06 mg/dl, P = 0.401). The patients experienced complete resolution or noticeable reduction of ascites (P < 0.001), significant reduction of liver size (16.7 ± 2.2 vs. 13.7 ± 1.7 cm, P = 0.018), and significant enlargement of the portal trunk (10.7 ± 2.5 vs. 13.4 ± 2.4 mm, P = 0.017) after TIPS compared to the pre-TIPS state.
TIPS may offer a potentially useful treatment for the GS-related HSOS.
评估经颈静脉肝内门体分流术（TIPS）治疗与食用紫背天葵（GS）相关的肝窦阻塞综合征（HSOS）的疗效和安全性。
我们回顾性分析了2014年1月至2019年9月期间在我院接受TIPS治疗的9例对支持治疗无效的GS相关HSOS患者。评估患者的安全性和疗效，包括TIPS并发症以及门体压力梯度（PPG）、腹水、总胆红素、肝脏大小和门静脉直径的变化。
9例患者TIPS手术均成功完成，未记录到与TIPS手术相关的技术并发症。所有患者的PPG均通过TIPS得到改善（TIPS术前平均PPG为30.4±5.2 vs. TIPS术后为13.0±4.1 mmHg，P = 0.008）。1例患者失访，其余8例患者存活，中位随访期为12个月（范围5 - 39个月）。尽管TIPS术后5 - 7天总胆红素较术前显著升高（3.57±1.58 vs. 4.82±2.06 mg/dl，P = 0.017），但在1个月随访时恢复到基线水平（3.53±2.72 vs. 4.82±2.06 mg/dl，P = 0.401）。与TIPS术前状态相比，患者腹水完全消退或明显减少（P < 0.001），肝脏大小显著减小（16.7±2.2 vs. 13.7±1.7 cm，P = 0.018），门静脉主干显著增宽（10.7±2.5 vs. 13.4±2.4 mm，P = 0.017）。
TIPS可能为GS相关HSOS提供一种潜在有效的治疗方法。
