Pais Raluca, Chouik Yasmina, Moga Lucile, Lebedel Louise, Silvain Christine, Genser Laurent, Weill Delphine, Larrue Hélène, Malézieux Emilie, Jezéquel Caroline, Robert Maud, Regnault Hélène, Dumortier Jérôme, Ratziu Vlad, Thabut Dominique, Rudler Marika
Sorbonne Université, Pitié- Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
INSERM UMR_S 938, Centre de Recherche Saint-Antoine, Paris, France.
Obes Surg. 2025 Feb;35(2):395-405. doi: 10.1007/s11695-024-07583-w. Epub 2024 Dec 29.
In cirrhotic patients, portal hypertension increases mortality after surgery. We evaluated the impact of pre-operative transjugular intrahepatic portosystemic shunt (TIPS) on the outcomes of bariatric surgery in cirrhosis.
Multicentric retrospective cohort. The decision for TIPS placement has been made according to hepatic venous pressure gradient (HVPG) values and centers' policy. The primary outcome: 1-year decompensation-free survival; secondary outcomes: 1-year acute-on-chronic liver failure (ACLF) and survival.
Fifty-three patients were included (2010-2022): 92% Child-Pugh A, MELD score 8, age 55 years, BMI 38.3 ± 13 kg/m, 9 (18%) had TIPS. At baseline, patients with TIPS had more esophageal varices (89% vs 10%, p < 0.001), more previous decompensations (22% vs 0%, p = 0.002), and a higher HVPG (14 vs 7 mmHg, p < 0.001). All patients in the TIPS group had clinically significant portal hypertension vs 11% of patients without TIPS, p < 0.001. One-year decompensation-free survival was 77.8% and 93.2% in patients with and without TIPS, p = 0.064. ALCF occurred in 3 patients (6.8%) without TIPS and none with TIPS. All patients were alive 1 year after surgery.
In patients with cirrhosis and clinically significant portal hypertension (CSPH) undergoing bariatric surgery, TIPS placement was safe and had similar outcomes after surgery as patients without TIPS.
在肝硬化患者中，门静脉高压会增加手术后的死亡率。我们评估了术前经颈静脉肝内门体分流术（TIPS）对肝硬化患者减肥手术结局的影响。
多中心回顾性队列研究。根据肝静脉压力梯度（HVPG）值和各中心的政策决定是否进行TIPS植入。主要结局：1年无失代偿生存；次要结局：1年慢加急性肝衰竭（ACLF）和生存情况。
纳入53例患者（2010 - 2022年）：92%为Child-Pugh A级，终末期肝病模型（MELD）评分8分，年龄55岁，体重指数（BMI）38.3±13kg/m²，9例（18%）接受了TIPS。基线时，接受TIPS的患者有更多食管静脉曲张（89%对10%，p<0.001），更多既往失代偿情况（22%对0%，p = 0.002），且HVPG更高（14对7mmHg，p<0.001）。TIPS组所有患者均有临床显著性门静脉高压，而未接受TIPS的患者中这一比例为11%，p<0.001。接受TIPS和未接受TIPS的患者1年无失代偿生存率分别为77.8%和93.2%，p = 0.064。未接受TIPS的患者中有3例（6.8%）发生ACLF，接受TIPS的患者中无1例发生。所有患者术后1年均存活。
在接受减肥手术的肝硬化和临床显著性门静脉高压（CSPH）患者中，TIPS植入是安全的，术后结局与未接受TIPS的患者相似。
