Spiess S E, Matalon T A, Jensen D M, Rosenblate H J, Brunner M C, Ganger D R
Section of Digestive Diseases, Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois, USA.
Am J Gastroenterol. 1995 Aug;90(8):1238-43.
Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment of severe portal hypertension complications. Liver transplantation (LT) candidacy has not been a prerequisite to TIPS placement in some medical centers.
To investigate the outcome and survival of non-LT candidates after TIPS.
From November 1991 to February 1994, all patients referred for TIPS placement were evaluated for LT candidacy. Exclusions for LT included: age (> 70 yr), other significant medical conditions, or noncompliance. Indications for TIPS included refractory variceal bleeding during an acute bleed, recurrent bleeding after more than or equal to four sessions of sclerotherapy, or refractory ascites.
Sixty patients received TIPS. Nineteen were considered non-LT candidates. Over a 2-yr follow-up, 14 of these non-LT candidates did not survive. Their median age was 63.5 compared with 56.5 yr for LT candidate nonsurvivors (p < 0.05). Among the 14 non-LT candidate nonsurvivors, 10 were Childs C class, and eight had emergent TIPS placement. The 2-year mortality rate was 84% for non-LT candidates versus 24% for LT candidates. Median survival time for non-LT candidates was 2.6 months compared with 20 months in the LT candidates (p < 0.001). Only one death was due to a TIPS-related complication.
TIPS is unquestionably an advancement in the management of patients with portal hypertension complications. Non-LT candidates, compared with LT candidates, tended to be older and of a Child-Pugh C class, and they had survival rates often less than 90 days post-TIPS. Given these high mortality rates, we need to address whether TIPS is indicated in these non-LT candidates.
经颈静脉肝内门体分流术（TIPS）是治疗严重门静脉高压并发症的有效方法。在一些医疗中心，肝移植（LT）候选资格并非TIPS置入的先决条件。
研究TIPS术后非LT候选患者的结局和生存情况。
1991年11月至1994年2月，对所有接受TIPS置入的患者进行LT候选资格评估。LT排除标准包括：年龄（>70岁）、其他严重疾病或不依从。TIPS的适应证包括急性出血期间难治性静脉曲张出血、≥4次硬化治疗后复发出血或难治性腹水。
60例患者接受了TIPS。19例被认为不适合LT。在2年的随访中，这些非LT候选患者中有14例死亡。他们的中位年龄为63.5岁，而LT候选死亡患者的中位年龄为56.5岁（p<0.05）。在14例非LT候选死亡患者中，10例为Childs C级，8例为急诊TIPS置入。非LT候选患者的2年死亡率为84%，而LT候选患者为24%。非LT候选患者的中位生存时间为2.6个月，而LT候选患者为20个月（p<0.001）。仅1例死亡与TIPS相关并发症有关。
TIPS无疑是门静脉高压并发症患者管理方面的一项进展。与LT候选患者相比，非LT候选患者往往年龄更大，属于Child-Pugh C级，且TIPS术后生存率通常低于90天。鉴于这些高死亡率，我们需要探讨TIPS是否适用于这些非LT候选患者。
