Le Moine O, Devière J, Ghysels M, François E, Rypens F, Van Gansbeke D, Bourgeois N, Adler M
Dept. of Gastroenterology and Radiology, Hôpital Erasme, Université Libre de Bruxelles, Belgium.
Scand J Gastroenterol Suppl. 1994;207:23-8. doi: 10.3109/00365529409104190.
Variceal bleeding carries high early mortality, especially after failure of conventional treatments such as endoscopic injection therapy. The present study analyses the efficacy of transjugular intrahepatic portosystemic stent shunt (TIPS) in cirrhotic patients after failure of sclerotherapy for variceal bleeding.
Twenty-four consecutive patients underwent TIPS in this indication.
The procedure was successful in all patients, with reduction of size or disappearance of varices in 96% of them. Four patients (17%) developed encephalopathy and six (25%) rebled during the follow-up period (median 5 months; range 1-19). Thirty-day mortality was only 17% and 29% during the follow-up period. Deaths were mainly due to liver failure, especially after procedures performed in emergency. Significant decrease in liver function was observed in the days following the procedure. To maintain long-term patency of the shunt, revision was required in nine patients (38%).
TIPS seems to be a promising salvage therapeutic procedure after failed sclerotherapy, but this needs to be addressed in controlled trials.
静脉曲张破裂出血具有较高的早期死亡率，尤其是在诸如内镜注射治疗等传统治疗方法失败后。本研究分析了经颈静脉肝内门体分流术（TIPS）在静脉曲张破裂出血硬化治疗失败后的肝硬化患者中的疗效。
24例连续患者因该适应证接受了TIPS治疗。
所有患者手术均成功，96%的患者静脉曲张缩小或消失。4例患者（17%）出现肝性脑病，6例患者（25%）在随访期间（中位时间5个月；范围1 - 19个月）再次出血。30天死亡率仅为17%，随访期间为29%。死亡主要归因于肝功能衰竭，尤其是在急诊手术之后。术后数天观察到肝功能显著下降。为维持分流的长期通畅，9例患者（38%）需要进行修复。
TIPS似乎是硬化治疗失败后的一种有前景的挽救性治疗方法，但这需要在对照试验中加以验证。
