Strauss R M, Martin L G, Kaufman S L, Boyer T D
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Am J Gastroenterol. 1994 Sep;89(9):1520-2.
To investigate the safety and effectiveness of performing transjugular intrahepatic portal systemic shunt (TIPS) for the management of symptomatic cirrhotic hydrothorax in patients with advanced cirrhosis.
TIPS was performed by standard technique after portal vein patency had been established by ultrasound. Portal-hepatic vein pressure gradient was determined before and after placement of the shunt. A portal-hepatic vein gradient of less than 12 mm Hg was the treatment goal.
Five patients underwent TIPS placement over an 11-month period. Despite use of diuretics, the patients had required a median of seven thoracenteses (range 2-11) for control of symptoms preceding placement of the shunt. A TIPS was placed without serious complications in all five patients. In two patients, insertion of the shunt was associated with no further need for thoracentesis. The other three patients had recurrent need for thoracentesis. These three patients were found to have occluded shunts which were rendered patent by angioplasty and/or urokinase. Subsequently, two required no further thoracentesis, whereas, in the other patient, the need for thoracentesis was decreased dramatically.
TIPS appears to be a safe and useful technique for the management of patients with symptomatic cirrhotic hydrothorax that is refractory to medical therapy. Recurrence of the pleural effusion after placement of TIPS may be an indication of shunt occlusion.
探讨经颈静脉肝内门体分流术（TIPS）治疗晚期肝硬化患者症状性肝硬化胸腔积液的安全性和有效性。
在超声确定门静脉通畅后，采用标准技术进行TIPS。在放置分流器前后测定门静脉-肝静脉压力梯度。门静脉-肝静脉梯度小于12 mmHg为治疗目标。
在11个月期间，5例患者接受了TIPS放置。尽管使用了利尿剂，但患者在放置分流器前为控制症状平均需要进行7次胸腔穿刺（范围2-11次）。所有5例患者放置TIPS均无严重并发症。2例患者放置分流器后无需进一步胸腔穿刺。其他3例患者反复需要胸腔穿刺。发现这3例患者的分流器堵塞，通过血管成形术和/或尿激酶使其通畅。随后，2例患者无需进一步胸腔穿刺，而另1例患者胸腔穿刺的需求显著减少。
TIPS似乎是治疗药物治疗无效的症状性肝硬化胸腔积液患者的一种安全有效的技术。TIPS放置后胸腔积液复发可能提示分流器堵塞。
