Menegaux F, Baker E, Keeffe E B, Monge H, Egawa H, Esquivel C O
Department of Transplantation, California Pacific Medical Center, San Francisco 94115.
World J Surg. 1994 Nov-Dec;18(6):866-70; discussion 870-1. doi: 10.1007/BF00299089.
Transjugular intrahepatic portosystemic shunt (TIPS) is being increasingly utilized prior to liver transplantation for portal hypertensive bleeding refractory to sclerotherapy or as initial management of variceal bleeding. The impact of TIPS on subsequent orthotopic liver transplantation (OLT) is uncertain. The purpose of this study was to analyze the effect of TIPS on OLT in terms of operative transfusion requirements, operative time, length of hospital stay, and graft and patient survival. The results in 17 patients undergoing TIPS for control of initial or recurrent variceal bleeding prior to OLT between June 1991 and December 1992 were compared to two other groups undergoing transplantation: 32 control patients with a history of variceal bleeding not treated by TIPS and 11 patients with a previous surgical portosystemic shunt. Compared with control and surgical shunt patients, patients who underwent TIPS had less transfusion requirement for packed red blood cells and fresh frozen plasma during OLT. The operative time and hospital stay of the TIPS patients were slightly, but not significantly, less. In contrast to patients having TIPS, the patients with a history of a previous surgical shunt had an increased requirement for packed red blood cells, longer operative time, and longer stay in the intensive care unit and hospital. Two patients had recurrent variceal bleeding after TIPS; one patient was found to have an occluded stent, and the other patient (with a patent stent) responded to sclerotherapy. Of the 14 patients with ascites, 8 patients improved and 6 patients had complete resolution after TIPS. There were no major complications related to TIPS, although 3 patients had new or recurrent hepatic encephalopathy that was easily manageable.(ABSTRACT TRUNCATED AT 250 WORDS)
经颈静脉肝内门体分流术（TIPS）在肝移植前越来越多地用于治疗硬化疗法难治的门静脉高压出血或作为静脉曲张出血的初始治疗方法。TIPS对后续原位肝移植（OLT）的影响尚不确定。本研究的目的是从手术输血需求、手术时间、住院时间以及移植物和患者生存率方面分析TIPS对OLT的影响。将1991年6月至1992年12月期间17例在OLT前接受TIPS以控制初次或复发性静脉曲张出血的患者的结果与另外两组接受移植的患者进行比较：32例有静脉曲张出血病史但未接受TIPS治疗的对照患者和11例既往接受过外科门体分流术的患者。与对照患者和接受外科分流术的患者相比，接受TIPS的患者在OLT期间对浓缩红细胞和新鲜冰冻血浆的输血需求较少。TIPS患者的手术时间和住院时间略短，但无显著差异。与接受TIPS的患者相比，既往有外科分流术病史的患者对浓缩红细胞的需求增加，手术时间更长，在重症监护病房和医院的停留时间更长。2例患者在TIPS后出现复发性静脉曲张出血；1例患者发现支架闭塞，另1例患者（支架通畅）硬化疗法有效。14例腹水患者中，8例改善，6例在TIPS后腹水完全消退。尽管有3例患者出现新的或复发性肝性脑病，但易于处理，未发生与TIPS相关的重大并发症。（摘要截短至250字）
