Jalan R, Redhead D N, Allan P L, Hayes P C
Centre for Liver and Digestive Diseases, Royal Infirmary of Edinburgh, UK.
Eur J Gastroenterol Hepatol. 1996 Apr;8(4):381-5. doi: 10.1097/00042737-199604000-00017.
TIPSS is effective in reducing portal hypertension and provides access to the portal system for direct pressure measurements.
To assess the incidence and severity of haemolysis and its course following TIPSS, and also to assess changes in spleen size and any relationship to changes in the platelet and white cell count and haemoglobin concentration.
A prospective study.
Twenty-three patients undergoing TIPSS with a mean follow-up of 8 months (SE 1.2) were studied. Male-female ratio was 13:10 and the mean age was 53.6 years (SE 1.7). Full blood count, reticulocyte count, serum haptoglobin, urinary haemosiderin, examination of the peripheral blood smear and spleen size (ultrasonography) were measured prior to and 3, 7 and 30 days after TIPSS and 6-monthly thereafter.
Seven patients (30.4%) developed haemolysis, which was clinically significant in three (13%). This settled spontaneously within 2 weeks of TIPSS. Portal pressure gradient was reduced from a mean of 21.9 (SE 1.6) to 9.5 (SE 1) mmHg (P < 0.001) and did not change significantly thereafter. Haemoglobin concentration improved significantly from a mean of 89 (SE 16) to 113 (SE 19) g/l (P < 0.05) after TIPSS. Significant changes in spleen size and platelet count occurred, with a reduction in the former from 16.9 (SE 1.1) to 13.7 cm (SE 2.4) (P < 0.01) and an increase in the latter from 85.9 (SE 8.4) to 135.3 x 10(9)/l (SE 16.8) (P < 0.01). No significant correlations were found between the changes in the portal pressure gradient, spleen size and platelet count. There was no significant change in the white cell count.
Transient significant haemolysis occurs in about 13% of patients following TIPSS. TIPSS is useful for reducing splenomegaly and improving thrombocytopenia and haemoglobin. There is no correlation between the changes in portal pressure gradient, spleen size and platelet count.
经颈静脉肝内门体分流术（TIPSS）在降低门静脉高压方面有效，且可进入门静脉系统进行直接压力测量。
评估TIPSS术后溶血的发生率、严重程度及其病程，同时评估脾脏大小的变化以及与血小板、白细胞计数和血红蛋白浓度变化的关系。
一项前瞻性研究。
对23例行TIPSS的患者进行研究，平均随访8个月（标准误1.2）。男女比例为13:10，平均年龄为53.6岁（标准误1.7）。在TIPSS术前、术后3天、7天、30天以及此后每6个月测量全血细胞计数、网织红细胞计数、血清触珠蛋白、尿含铁血黄素、外周血涂片检查以及脾脏大小（超声检查）。
7例患者（30.4%）发生溶血，其中3例（13%）具有临床意义。溶血在TIPSS术后2周内自发缓解。门静脉压力梯度从平均21.9（标准误1.6）降至9.5（标准误1）mmHg（P<0.001），此后无显著变化。TIPSS术后血红蛋白浓度从平均89（标准误16）显著提高至113（标准误19）g/l（P<0.05）。脾脏大小和血小板计数发生显著变化，前者从16.9（标准误1.1）降至13.7 cm（标准误2.4）（P<0.01），后者从85.9（标准误8.4）升至135.3×10⁹/l（标准误16.8）（P<0.01）。门静脉压力梯度、脾脏大小和血小板计数的变化之间未发现显著相关性。白细胞计数无显著变化。
约13%的患者在TIPSS术后发生短暂的显著溶血。TIPSS有助于减轻脾肿大、改善血小板减少和血红蛋白水平。门静脉压力梯度、脾脏大小和血小板计数的变化之间无相关性。
