经颈静脉肝内门体分流术在门静脉高压症治疗中作用的多中心研究。
Multicenter investigation of the role of transjugular intrahepatic portosystemic shunt in management of portal hypertension.
作者信息
Coldwell D M, Ring E J, Rees C R, Zemel G, Darcy M D, Haskal Z J, McKusick M A, Greenfield A J
机构信息
Department of Radiology, University of Washington Medical Center, Seattle 98195, USA.
出版信息
Radiology. 1995 Aug;196(2):335-40. doi: 10.1148/radiology.196.2.7617842.
PURPOSE
To determine the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) placement, a prospective multicenter trial was undertaken.
MATERIALS AND METHODS
In eight institutions, 96 patients underwent TIPS placement after failed sclero-therapy (Child-Pugh class A [n = 24], class B [n = 38], and class C [n = 34]), with follow-up for 6 months (with ultrasonography and angiography and clinical and laboratory studies).
RESULTS
TIPS placement was successful in all patients (mean initial portosystemic pressure gradient, 22.8 mm Hg + 6.7 [standard deviation]; mean decrease after placement, 12.8 mm Hg + 5.2), with variceal embolization in 25 patients. Complications included liver capsule puncture (n = 12), hepatic artery puncture (n = 3), main portal vein puncture (n = 1), and increased encephalopathy (n = 28). The 30-day mortality rate was 0% for patients with Child class A disease, 18% for class B, and 40% for class C. At 6 months, primary patency was 88% and assisted patency was 94%.
CONCLUSION
The risk associated with TIPS placement is reasonable, and it is an effective procedure for the treatment of portal hypertension.
目的
为了确定经颈静脉肝内门体分流术（TIPS）置入的安全性和有效性，开展了一项前瞻性多中心试验。
材料与方法
在八家机构中，96例患者在硬化治疗失败后（Child-Pugh A级[n = 24]、B级[n = 38]和C级[n = 34]）接受了TIPS置入，并进行了6个月的随访（包括超声检查、血管造影以及临床和实验室研究）。
结果
所有患者的TIPS置入均成功（平均初始门体压力梯度为22.8 mmHg ± 6.7[标准差]；置入后平均下降12.8 mmHg ± 5.2），25例患者出现静脉曲张栓塞。并发症包括肝包膜穿刺（n = 12）、肝动脉穿刺（n = 3）、门静脉主干穿刺（n = 1）以及肝性脑病加重（n = 28）。Child A级疾病患者的30天死亡率为0%，B级为18%，C级为40%。6个月时，原发性通畅率为88%，辅助通畅率为94%。
结论
TIPS置入相关风险是合理的，它是治疗门静脉高压的一种有效方法。
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