Rossi P, Maccioni F, Salvatori F M, Bezzi M, Gandini R, Broglia L, Ingianna D
III Cattedra, Università degli Studi di Roma, La Sapienza.
Radiol Med. 1994 May;87(5):585-96.
December 1991 through November 1993, fifty-five patients underwent TIPS with the following indications: failed sclerotherapy or surgery (25 patients), bleeding from gastric varices (3 patients), patients waiting for liver transplantation (11 patients) and refractory ascites (9 patients). Seven patients were included in a randomized TIPS vs sclerotherapy trial. The average follow-up of living patients is 4.6 months (range: 1-16 months). The technical success rate was 100%. The portosystemic gradient decreased from 22 mmHg to 10.7 mmHg. After TIPS all patients were followed-up with endoscopic, angiographic and color Doppler examinations and underwent periodic clinical checks. Early (5-day) angiographic follow-up exams showed partial stent thrombosis in 5/32 cases (15.5%) and complete stent thrombosis in 3 cases (9.3%). Late angiographic follow-up exams (1-9 months) showed complete stent occlusion in 2 cases, stent stenosis in 8 cases and hepatic vein stenosis in 5 cases. At present, 37 patients are alive (67%); 5 patients have undergone liver transplantation (9%), and 13 patients died (24%)--3 within 48-72 hours after the procedure and 10 in 1-8 months. Five patients had recurrent bleeding (9%). Ascites was reduced or disappeared in 8/9 cases. Early clinical complications occurred in 12% of cases and were treated with medical therapy. Within one year, signs of encephalopathy developed in 13 patients (23%) and were successfully treated with medical therapy.
1991年12月至1993年11月，55例患者接受了经颈静脉肝内门体分流术（TIPS），其适应证如下：硬化治疗或手术失败（25例）、胃静脉曲张出血（3例）、等待肝移植的患者（11例）和顽固性腹水（9例）。7例患者纳入了TIPS与硬化治疗的随机对照试验。存活患者的平均随访时间为4.6个月（范围：1 - 16个月）。技术成功率为100%。门体静脉压力梯度从22 mmHg降至10.7 mmHg。TIPS术后所有患者均接受内镜、血管造影和彩色多普勒检查，并进行定期临床检查。早期（5天）血管造影随访检查显示，32例中有5例（15.5%）出现部分支架血栓形成，3例（9.3%）出现完全支架血栓形成。晚期血管造影随访检查（1 - 9个月）显示，2例出现完全支架闭塞，8例出现支架狭窄，5例出现肝静脉狭窄。目前，37例患者存活（67%）；5例患者接受了肝移植（9%），13例患者死亡（24%）——3例在术后48 - 72小时内死亡，10例在1 - 8个月内死亡。5例患者出现复发性出血（9%）。9例中有8例腹水减少或消失。12%的病例出现早期临床并发症，经药物治疗。1年内，13例患者（23%）出现肝性脑病迹象，经药物治疗成功治愈。
