Zhang W W, Ren J Z, Wei T, Wang Y P, Xue J F, Chen P F, Zhou X L, Han X W
Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Department of Interventional Radiology, Anyang Fifth People's Hospital, Anyang 455099, China.
Zhonghua Nei Ke Za Zhi. 2022 May 1;61(5):548-551. doi: 10.3760/cma.j.cn112138-20210902-00608.
To explore the medium-long term efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for gastrointestinal hemorrhage in patients with idiopathic non-cirrhotic portal hypertension (INCPH). From March 2013 to July 2018, clinical data of 13 INCPH patients, including 5 males, 8 females,with gastrointestinal hemorrhage were retrospectively analyzed, who were diagnosed at the First Affiliated Hospital of Zhengzhou University, Anyang Fifth People' s Hospital and Yuncheng Central Hospital. All patients received TIPS treatment. The general information, postoperative survival rate, the incidence of rebleeding, shunt dysfunction rate, and incidence of hepatic encephalopathy were analyzed. All 13 patients with INCPH completed TIPS successfully with an average age of 45±8 (33 to 59) years. The hepatic venous pressure gradient (HVPG) decreased from 20.0-26.0 (22.6±1.9) mmHg before procedure to 8.0-14.0 (9.4±3.2) mmHg after. The median follow-up time was 44±7 (31 to 53) months. One patient died of liver failure 27 months after TIPS. Hepatic encephalopathy occurred cumulatively in 1 case (1/13), 1 case (1/13) and 1 case (1/13) in 12, 24 and 36 months after TIPS. Stent restenosis occurred cumulatively in 2 cases (2/13), 3 cases (3/13) and 3 cases (3/13) in 12, 24 and 36 months after TIPS. Portal vein thrombosis occurred cumulatively in 2 cases (2/13), and no primary liver cancer developed. TIPS is safe and effective in the treatment of INCPH with gastrointestinal bleeding with favorable medium-long term outcome.
探讨经颈静脉肝内门体分流术（TIPS）治疗特发性非肝硬化门静脉高压症（INCPH）患者胃肠道出血的中长期疗效。回顾性分析2013年3月至2018年7月在郑州大学第一附属医院、安阳市第五人民医院和运城市中心医院确诊的13例因胃肠道出血住院的INCPH患者的临床资料，其中男性5例，女性8例。所有患者均接受TIPS治疗。分析患者的一般资料、术后生存率、再出血发生率、分流道功能障碍发生率及肝性脑病发生率。13例INCPH患者均成功完成TIPS治疗，平均年龄45±8（33至59）岁。肝静脉压力梯度（HVPG）由术前的20.0 - 26.0（22.6±1.9）mmHg降至术后的8.0 - 14.0（9.4±3.2）mmHg。中位随访时间为44±7（31至53）个月。1例患者在TIPS术后27个月死于肝衰竭。TIPS术后12、24和36个月肝性脑病累积发生率分别为1例（1/13）、1例（1/13）和1例（1/13）。TIPS术后12、24和36个月支架再狭窄累积发生率分别为2例（2/13）、3例（3/13）和3例（3/13）。门静脉血栓累积发生率为2例（2/13），未发生原发性肝癌。TIPS治疗INCPH合并胃肠道出血安全有效，中长期疗效良好。
