经颈静脉肝内门体分流术治疗肝硬化顽固性腹水后的临床反应

Clinical response after transjugular intrahepatic portosystemic stent shunt insertion for refractory ascites in cirrhosis.

作者信息

Forrest E H, Stanley A J, Redhead D N, McGilchrist A J, Hayes P C

机构信息

Department of Medicine, Royal Infirmary of Edinburgh, UK.

出版信息

Aliment Pharmacol Ther. 1996 Oct;10(5):801-6. doi: 10.1046/j.1365-2036.1996.60202000.x.

DOI:10.1046/j.1365-2036.1996.60202000.x

PMID:8899090

Abstract

BACKGROUND

Transjugular intrahepatic portosystemic stent shunts (TIPSS) have been used successfully to reduce portal pressure in the context of variceal haemorrhage. Recent interest has focused on the possible use of TIPSS to manage refractory ascites.

AIM

To study the effect of TIPSS insertion in 18 patients with refractory ascites.

RESULTS

Response rates were 33.3%, 50%, 33.3% and 26.7% at 1 week, 4 weeks, 3 months and 6 months, respectively. Overall mortality was 50% with a new or worsening encephalopathy rate also of 50%. Patients with lower serum bilirubin and serum creatinine prior to TIPSS insertion had greater response at 1 and 4 weeks, respectively. There was no improvement in either liver or renal function after TIPSS insertion by standard laboratory tests, although serum sodium increased in the responders after 1 month.

CONCLUSION

TIPSS improves refractory ascites in only a minority of patients, and is associated with high encephalopathy and mortality rates.

摘要

背景

经颈静脉肝内门体分流术（TIPSS）已成功用于降低静脉曲张出血时的门静脉压力。近期的研究兴趣集中在TIPSS用于治疗顽固性腹水的可能性。

目的

研究TIPSS植入对18例顽固性腹水患者的疗效。

结果

1周、4周、3个月和6个月时的缓解率分别为33.3%、50%、33.3%和26.7%。总死亡率为50%，新发或恶化的肝性脑病发生率也为50%。TIPSS植入前血清胆红素和血清肌酐较低的患者在1周和4周时分别有更大的缓解。尽管反应者在1个月后血清钠升高，但标准实验室检查显示TIPSS植入后肝功能和肾功能均无改善。