Gschwantler M, Gebauer A, Rohrmoser M, Schrutka-Kölbl C, Vavrik J, Brownstone E, Tscholakoff D, Weiss W
Fourth Department of Internal Medicine, KA Rudolfstiftung, Vienna, Austria.
Eur J Gastroenterol Hepatol. 1997 Jan;9(1):15-20. doi: 10.1097/00042737-199701000-00007.
Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) is a relatively new therapy for variceal bleeding. The aim of this study was to assess clinical course 2 years after TIPS procedure.
The study was designed as a prospective, uncontrolled cohort study.
Forty-six patients who underwent successful TIPS implantation were followed prospectively by clinical examinations, duplex sonography and portal venography. Mean follow-up in surviving patients was 24.1 +/- 9.0 months.
The cumulative rate of survival was 80.4% at 1 year and 70.2% at 2 years. The cumulative rebleeding rate was 12.4% at 1 year and 21.3% at 2 years. The mortality rate of episodes of variceal rebleeding was 22.2%. Variceal rebleeding was associated with shunt abnormalities, and successful shunt revision resulted in control of the bleeding. The cumulative incidence of shunt stenosis or occlusion was 41.2% at 1 year and 54.9% at 2 years. Of those patients without shunt abnormalities after 1 year, 23.3% developed shunt stenosis or occlusion during the second year after TIPS procedure. Shunt revision was successful in 96.6% of cases. Secondary patency rate was 88.1% after 2 years.
Successful TIPS implantation results in a low rate of morbidity and mortality from variceal rebleeding over 2 years. TIPS creation in combination with careful follow-up examinations represents an effective long-term treatment of recurrent variceal bleeding. Even in patients in whom no shunt abnormality is detected during the first year, routine duplex follow-up examinations should be continued at 3-month intervals.
经颈静脉肝内门体分流术（TIPS）植入是一种相对较新的治疗静脉曲张出血的方法。本研究的目的是评估TIPS术后2年的临床病程。
本研究设计为一项前瞻性、非对照队列研究。
对46例行TIPS植入成功的患者进行前瞻性临床检查、双功超声检查和门静脉造影。存活患者的平均随访时间为24.1±9.0个月。
1年时累积生存率为80.4%，2年时为70.2%。1年时累积再出血率为12.4%，2年时为21.3%。静脉曲张再出血发作的死亡率为22.2%。静脉曲张再出血与分流异常有关，成功的分流修复可控制出血。1年时分流狭窄或闭塞的累积发生率为41.2%，2年时为54.9%。在1年后无分流异常的患者中，23.3%在TIPS术后第二年出现分流狭窄或闭塞。分流修复在96.6%的病例中成功。2年后二级通畅率为88.1%。
成功植入TIPS可使静脉曲张再出血导致的发病率和死亡率在2年内保持较低水平。TIPS联合仔细的随访检查是复发性静脉曲张出血的一种有效的长期治疗方法。即使在第一年未检测到分流异常的患者中，也应每3个月进行一次常规双功超声随访检查。
