Zhang Jian-Bin, Chen Jie, Zhou Jin, Wang Xu-Ming, Chen Shu, Chu Jian-Guo, Liu Peng, Ye Zhi-Dong
Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing 100029, China.
Department of Interventional Radiology, Affiliated People's Hospital of Inner Mongolia Medical University, Hohhot 010020, Inner Mongolia Autonomous Region, China.
World J Clin Cases. 2021 Jul 6;9(19):5179-5190. doi: 10.12998/wjcc.v9.i19.5179.
Portal vein thrombosis (PVT) was previously a contraindication for trans-jugular intrahepatic portosystemic shunt (TIPS).
To perform a systematic review and meta-analysis of the current available studies investigating outcomes of TIPS for cirrhotic patient with PVT.
Multiple databases were systematically searched to identify studies investigating the outcomes of TIPS for cirrhotic patients with PVT. The quality of studies was assessed by Cochrane Collaboration method and Methodological Index for Non-Randomized Studies. The demographic data, outcomes, combined treatment, and anticoagulation strategy were extracted.
Twelve studies were identified with 460 patients enrolled in the analysis. The technical success rate was 98.9% in patients without portal vein cavernous transformation and 92.3% in patients with portal vein cavernous transformation. One-year portal vein recanalization rate was 77.7%, and TIPS patency rate was 84.2%. The cumulative encephalopathy rate was 16.4%. One-year overall survival was 87.4%.
TIPS is indicated for portal hypertension related complications and the restoration of pre-transplantation portal vein patency in cirrhotic patients with PVT. Cavernous transformation is an indicator for technical failure. Post-TIPS anticoagulation seems not mandatory. Simultaneous TIPS and percutaneous mechanical thrombectomy device could achieve accelerated portal vein recanalization and decreased thrombolysis-associated complications, but further investigation is still needed.
门静脉血栓形成（PVT）曾是经颈静脉肝内门体分流术（TIPS）的禁忌证。
对目前有关TIPS治疗肝硬化合并PVT患者结局的现有研究进行系统评价和荟萃分析。
系统检索多个数据库，以识别有关TIPS治疗肝硬化合并PVT患者结局的研究。采用Cochrane协作方法和非随机研究方法学指数评估研究质量。提取人口统计学数据、结局、联合治疗及抗凝策略。
共纳入12项研究，460例患者纳入分析。无门静脉海绵样变性患者的技术成功率为98.9%，有门静脉海绵样变性患者的技术成功率为92.3%。1年门静脉再通率为77.7%，TIPS通畅率为84.2%。累积肝性脑病发生率为16.4%。1年总生存率为87.4%。
TIPS适用于肝硬化合并PVT患者门静脉高压相关并发症及移植前门静脉通畅的恢复。海绵样变性是技术失败的指标。TIPS术后抗凝似乎并非必需。同时进行TIPS和经皮机械血栓切除术可实现门静脉加速再通并减少溶栓相关并发症，但仍需进一步研究。
