经颈静脉肝内门体分流术（TIPS）、带隧道的腹膜导管或腹水抽吸泵治疗难治性腹水患者的临床结局比较。
Comparison of clinical outcomes in patients with refractory ascites treated with either TIPS, tunneled peritoneal catheter, or ascites pump.
作者信息
Schütte Sarah L, Tiede Anja, Mauz Jim B, Rieland Hannah, Kabelitz Martin, Iker Robin, Richter Nicolas, Meyer Bernhard, Heidrich Benjamin, Wedemeyer Heiner, Maasoumy Benjamin, Tergast Tammo L
机构信息
Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany.
German Center for Infection Research (DZIF), Hannover-Braunschweig, Germany.
出版信息
Hepatol Commun. 2025 Jan 16;9(2). doi: 10.1097/HC9.0000000000000620. eCollection 2025 Feb 1.
BACKGROUND
Refractory ascites (RA) remains a serious complication in patients with cirrhosis. Currently, the insertion of a TIPS is considered the standard of care in these patients. To achieve symptom control in those with TIPS contraindications, tunneled peritoneal catheters (PeCa) or ascites pumps were introduced. However, data comparing the available treatment options are scarce. This study aims to compare outcomes among patients with RA treated either with TIPS, PeCa, or ascites pump.
METHODS
All patients with RA and cirrhosis treated at Hannover Medical School between 2009 and 2023 were evaluated. Endpoints included mortality, acute kidney injury (AKI), hyponatremia, peritonitis, and rehospitalization rate. Propensity score matching was conducted to adjust for group differences.
RESULTS
First, 31 patients with ascites pump were compared to 62 patients with a PeCa after propensity score matching. There were no differences regarding mortality nor incidences of AKI, hyponatremia, or rehospitalization. However, incidences of peritonitis and explantation were lower in those with ascites pump (HR 0.32, 95% CI: 0.15-0.70, and HR 0.32, 95% CI: 0.14-0.71, respectively). Second, 35 ascites pump patients were matched with 70 individuals with TIPS. No differences regarding mortality or peritonitis incidence were observed. Ascites pump patients showed higher incidences of AKI (HR 4.55, 95% CI: 2.53-8.18) and hyponatremia (HR 4.13, 95% CI: 2.08-8.22). Last, 129 patients with TIPS were compared to 129 with PeCa. Mortality was comparable, while incidences of AKI (HR 5.01, 95% CI: 3.36-7.47), hyponatremia (HR 4.64, 95% CI: 3.03-7.12), and peritonitis (HR 2.19, 95% CI: 1.41-3.41) were higher in those with PeCa.
CONCLUSIONS
While ascites pump was associated with lower incidences of device infections and explantations, TIPS was associated with the lowest incidence of clinical complications in patients with RA.
背景
顽固性腹水（RA）仍是肝硬化患者的严重并发症。目前，经颈静脉肝内门体分流术（TIPS）的植入被认为是这些患者的标准治疗方法。为了控制有TIPS禁忌证患者的症状，引入了隧道式腹膜导管（PeCa）或腹水引流泵。然而，比较现有治疗方案的数据很少。本研究旨在比较接受TIPS、PeCa或腹水引流泵治疗的RA患者的预后。
方法
对2009年至2023年在汉诺威医学院接受治疗的所有RA和肝硬化患者进行评估。终点指标包括死亡率、急性肾损伤（AKI）、低钠血症、腹膜炎和再住院率。进行倾向评分匹配以调整组间差异。
结果
首先，在倾向评分匹配后，将31例使用腹水引流泵的患者与62例使用PeCa的患者进行比较。在死亡率、AKI、低钠血症或再住院发生率方面没有差异。然而，使用腹水引流泵的患者腹膜炎和装置移除率较低（风险比分别为0.32，95%可信区间：0.15 - 0.70，以及风险比0.32，95%可信区间：0.14 - 0.71）。其次，将35例使用腹水引流泵的患者与70例接受TIPS的患者进行匹配。未观察到死亡率或腹膜炎发生率的差异。使用腹水引流泵的患者AKI（风险比4.55，95%可信区间：2.53 - 8.18）和低钠血症（风险比4.13，95%可信区间：2.08 - 8.22）的发生率较高。最后，将129例接受TIPS的患者与129例使用PeCa的患者进行比较。死亡率相当，而使用PeCa的患者AKI（风险比5.01，95%可信区间：3.36 - 7.47）、低钠血症（风险比4.64，95%可信区间：3.03 - 7.12）和腹膜炎（风险比2.19，95%可信区间：1.41 - 3.41）的发生率较高。
结论
虽然腹水引流泵与较低的装置感染和移除率相关，但TIPS在RA患者中与最低的临床并发症发生率相关。
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