Santos Sara, Dantas Eduardo, Veloso Gomes Filipe, Luz José Hugo, Vasco Costa Nuno, Bilhim Tiago, Calinas Filipe, Martins Américo, Coimbra Élia
Gastroenterology and Hepatology Department, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal.
Gastroenterology and Hepatology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal.
GE Port J Gastroenterol. 2020 Dec;28(1):5-12. doi: 10.1159/000507894. Epub 2020 Jun 9.
Transjugular intrahepatic portosystemic shunt (TIPS) is used for decompressing clinically significant portal hypertension. The aims of this study were to evaluate clinical outcomes and adverse events associated with this procedure.
Retrospective single-center study including 78 patients submitted to TIPS placement between January 2015 and November 2018. Follow-up data were missing in 27 patients, and finally 51 patients were included in the study sample. Data collected from individual registries included demographics, comorbidities, laboratory results, complications, and clinical results according to the indication.
Average pre-TIPS portosystemic pressure gradient decreased from 18.1 ± 5 to 6 ± 3 mm Hg after TIPS placement. Indications for TIPS were refractory ascites (63%, = 49), recurrent or uncontrolled variceal bleeding (36%, = 28), and Budd-Chiari syndrome (1.3%, = 1). TIPS-related adverse events occurred in 29/51 (56.8%) patients, with hepatic encephalopathy (HE) in 21 (41%) patients, sepsis in 3, liver failure in 2, hemolytic anemia in 1, acute pulmonary edema in 1, and capsular perforation in 1 patient. Mean follow-up was 15.7 ± 15 months. First-month mortality was 11.7% ( = 6) (sepsis, = 3; acute liver failure, = 2; and recurrence of variceal bleeding, = 1) and was significantly higher for patients with Child-Pugh >9 points ( = 0.01), model of end-stage liver disease (MELD) scores >19 ( = 0.02), and for patients with a history of HE before the procedure ( = 0.001). Older age ( = 0.006) and higher levels of creatinine ( = 0.008) were significantly higher in patients developing HE after TIPS. Ascites persisted in 21.2% (7/33 patients) and was more frequent in patients with lower baseline albumin levels ( = 0.003). Recurrent variceal bleeding occurred in 22% ( = 4/18 patients) and was more frequent in patients with lower baseline hemoglobin levels ( = 0.03).
TIPS is effective in up to 80% of patients presenting with variceal bleeding or refractory ascites. Careful patient selection based on age and HE history may reduce adverse events after TIPS.
经颈静脉肝内门体分流术（TIPS）用于缓解具有临床意义的门静脉高压。本研究的目的是评估该手术的临床结局和不良事件。
一项回顾性单中心研究，纳入2015年1月至2018年11月期间接受TIPS置入术的78例患者。27例患者缺失随访数据，最终51例患者纳入研究样本。从个体登记处收集的数据包括人口统计学、合并症、实验室检查结果、并发症以及根据适应证的临床结果。
TIPS置入术后，平均术前门体压力梯度从18.1±5 mmHg降至6±3 mmHg。TIPS的适应证为顽固性腹水（63%，n = 49）、复发性或难以控制的静脉曲张出血（36%，n = 28）以及布加综合征（1.3%，n = 1）。29/51（56.8%）例患者发生了与TIPS相关的不良事件，其中21例（41%）发生肝性脑病（HE），3例发生脓毒症，2例发生肝功能衰竭，1例发生溶血性贫血，1例发生急性肺水肿，1例发生包膜穿孔。平均随访时间为15.7±15个月。第一个月的死亡率为11.7%（n = 6）（脓毒症，n = 3；急性肝衰竭，n = 2；静脉曲张出血复发，n = 1），Child-Pugh评分>9分的患者（P = 0.01）、终末期肝病模型（MELD）评分>19分的患者（P = 0.02）以及术前有HE病史的患者（P = 0.001）死亡率显著更高。发生TIPS术后HE的患者年龄较大（P = 0.006）且肌酐水平较高（P = 0.008）。2至%（7/33例患者）腹水持续存在，且基线白蛋白水平较低的患者更常见（P = 0.003）。18例患者中有4例（22%）发生静脉曲张出血复发，且基线血红蛋白水平较低的患者更常见（P = 0.03）。
TIPS对高达80%的静脉曲张出血或顽固性腹水患者有效。根据年龄和HE病史仔细选择患者可减少TIPS术后的不良事件。
