Menegaux F, Keeffe E B, Baker E, Egawa H, Concepcion W, Russell T R, Esquivel C O
Department of Transplantation, California Pacific Medical Center, San Francisco.
Arch Surg. 1994 Oct;129(10):1018-23; discussion 1023-4. doi: 10.1001/archsurg.1994.01420340028006.
To analyze the effect of previous transjugular intrahepatic portosystemic shunt (TIPS) vs surgical portosystemic shunt (SPS) on the outcome of orthotopic liver transplantation (OLT).
A case series of 38 patients who underwent OLT: 25 with a previous TIPS and 13 with a previous SPS.
A liver transplant center and interventional radiology service in a private, tertiary referral medical center.
Eighteen men and seven women who had a TIPS before OLT were compared with nine men and four women who had an SPS before OLT.
Operative transfusion requirements, operative time, length of hospital stay, postoperative liver chemistry studies, and graft and patient survival.
Compared with patients who had an SPS, patients who had a TIPS had significantly less median transfusion requirements for packed red blood cells (5 vs 12 U), fresh-frozen plasma (0 vs 8 U), and thrombocytes (0 vs 1 U). The median operative time (9 vs 13 hours), length of intensive care unit stay (3 vs 5 days), and length of hospital stay (12 vs 24 days) were also significantly less in patients who had a TIPS. The 2-year actuarial patient survival rate was 92% in both groups.
In patients undergoing OLT, TIPS is associated with reduced operative transfusion requirements, operative time, and length of intensive care unit and hospital stays compared with SPS. In the potential liver transplant candidate with refractory complications of portal hypertension, TIPS is preferred to SPS.
分析既往经颈静脉肝内门体分流术（TIPS）与外科门体分流术（SPS）对原位肝移植（OLT）结局的影响。
对38例行OLT的患者进行病例系列研究：25例既往有TIPS史，13例既往有SPS史。
一家私立三级转诊医疗中心的肝移植中心和介入放射科。
将18例男性和7例女性OLT术前有TIPS史的患者与9例男性和4例女性OLT术前有SPS史的患者进行比较。
手术输血需求量、手术时间、住院时间、术后肝脏生化检查以及移植物和患者生存率。
与有SPS史的患者相比，有TIPS史的患者红细胞悬液（5单位对12单位）、新鲜冰冻血浆（0单位对8单位）和血小板（0单位对1单位）的中位输血需求量显著更少。有TIPS史的患者中位手术时间（9小时对13小时）、重症监护病房住院时间（3天对5天）和住院时间（12天对24天）也显著更短。两组的2年患者精算生存率均为92%。
在接受OLT的患者中，与SPS相比，TIPS与手术输血需求量减少、手术时间缩短以及重症监护病房和住院时间缩短相关。在有门静脉高压难治性并发症的潜在肝移植候选患者中，TIPS优于SPS。
