Department of Radiology, Hospital Universitario y Politécnico La Fe, Avda. de Fernando Abril Martorell, 106, 46026, Valencia, Spain.
Department of Pediatric Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Pediatr Radiol. 2023 May;53(5):953-962. doi: 10.1007/s00247-022-05575-5. Epub 2022 Dec 29.
Experience with transjugular intrahepatic portosystemic shunts (TIPS) in the pediatric population, especially in infants, is limited.
To evaluate the feasibility, efficacy and safety of TIPS placement in infants.
This retrospective non-comparative observational cohort study analyzed all pediatric patients < 12 months of age treated with TIPS while waiting for liver transplant between October 2018 and April 2021. The sample consisted of 10 infants with chronic liver disease. All had refractory ascites and decreased portal vein size. Their mean age ± standard deviation was 5 ± 1 months and their mean weight was 5.4 ± 1.0 kg. We calculated the pediatric end-stage liver disease score and portosystemic gradients before and after TIPS placement. We used ultrasound to check for complications and to assess the presence of ascites. We used paired-sample t-test for the mean comparison of paired variables.
Ten TIPS procedures were performed that were technically and hemodynamically successful except for one, in which an extrahepatic portal puncture required surgical repair. Ascites resolved in three infants and was reduced in six. The portal vein size remained stable after TIPS placement. Four infants had early stent thrombosis and two had late stent thrombosis treated with angioplasty or covered stents.
TIPS placement in infants is a feasible, safe and effective procedure.
经颈静脉肝内门体分流术（TIPS）在儿科人群中的应用经验，尤其是在婴儿中，非常有限。
评估 TIPS 在婴儿中的可行性、疗效和安全性。
本回顾性非对照观察队列研究分析了 2018 年 10 月至 2021 年 4 月期间所有等待肝移植的 < 12 个月龄、因难治性腹水和门静脉缩小而行 TIPS 治疗的儿科患者。样本包括 10 例患有慢性肝病的婴儿。所有患儿均有难治性腹水且门静脉缩小。他们的平均年龄 ± 标准差为 5 ± 1 个月，平均体重为 5.4 ± 1.0 公斤。我们计算了 TIPS 放置前后的小儿终末期肝病评分和门体梯度。我们使用超声检查以检查并发症并评估腹水的存在。我们使用配对样本 t 检验来比较配对变量的平均值。
共进行了 10 次 TIPS 手术，除 1 例因肝外门静脉穿刺需行手术修复外，其余均为技术上和血流动力学上成功。3 例患儿腹水消退，6 例患儿腹水减少。TIPS 放置后门静脉大小保持稳定。4 例患儿发生早期支架血栓形成，2 例患儿发生晚期支架血栓形成，采用血管成形术或覆膜支架治疗。
TIPS 在婴儿中的应用是一种可行、安全且有效的方法。
