Cosenza C A, Hoffman A L, Friedman M L, Sher L S, Lopez R R, Van Allen R, Brown D H, Fraiman M H, Arnaout W, Vierling J, Makowka L
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Am Surg. 1996 Oct;62(10):835-9.
Variceal bleeding (VB) and ascites refractory to diuretics (RA) represent a significant cause of morbidity and mortality in patients with portal hypertension. Transjugular intrahepatic portosystemic shunts (TIPS) have been used effectively in patients with these complications, especially those individuals awaiting orthotopic liver transplantation (OLT). From April 1992 to July 1995, 41 adult patients underwent an attempt at TIPS placement for refractory VB or ascites at Cedars-Sinai Medical Center. Technical success was achieved in 37 of 41 cases (90.3%) with only two technical complications. Immediate control of hemorrhage and significant improvement of ascites was obtained in 91.9% and 83.5% of the patients, respectively. Six patients (16.2%) died within a week of TIPS placement due to uncontrollable ascites and multiorgan failure. Four of 31 patients (12.9%) developed mild to moderate grades of hepatic encephalopathy that was controlled with lactulose. Rebleeding from recurrent portal hypertension was noted in 5 of 31 cases (16.1%). Shunt stenosis or occlusion was seen in 7 of 31 cases (22.6%) at an average of 6.3 months following TIPS placement. Six patients underwent OLT within an average of 87 days after TIPS. These results indicate that TIPS appears to be an effective method for treatment of refractory VB and RA, especially for patients who are poor candidates for a surgical shunt or awaiting OLT. However, TIPS may not be considered a definitive solution for all patients with portal hypertension because of its current rate of shunt occlusion or stenosis.
静脉曲张破裂出血（VB）和利尿剂难治性腹水（RA）是门静脉高压患者发病和死亡的重要原因。经颈静脉肝内门体分流术（TIPS）已有效地应用于患有这些并发症的患者，尤其是那些等待原位肝移植（OLT）的患者。1992年4月至1995年7月，41例成年患者在雪松西奈医疗中心尝试接受TIPS植入术以治疗难治性VB或腹水。41例中有37例（90.3%）获得技术成功，仅出现两例技术并发症。分别有91.9%和83.5%的患者出血得到立即控制，腹水得到显著改善。6例患者（16.2%）在TIPS植入术后一周内死于无法控制的腹水和多器官功能衰竭。31例患者中有4例（12.9%）发生轻度至中度肝性脑病，经乳果糖治疗得到控制。31例中有5例（16.1%）出现复发性门静脉高压导致的再出血。31例中有7例（22.6%）在TIPS植入术后平均6.3个月出现分流狭窄或闭塞。6例患者在TIPS术后平均87天内接受了OLT。这些结果表明，TIPS似乎是治疗难治性VB和RA的有效方法，尤其是对于那些不适合进行外科分流或等待OLT的患者。然而，由于目前分流闭塞或狭窄的发生率，TIPS可能不能被视为所有门静脉高压患者的最终解决方案。
