Richter G M, Brado M, Simon C, Mädler U, Radeleff B, Roeren T, Sauer P, Kauffmann G W
Abteilung für Radiologische Diagnostik, Universitätsklinik Heidelberg.
Zentralbl Chir. 1997;122(2):108-16.
to demonstrate and document TIPSS-induced changes of the perfusion pattern of the liver with special reference to several rheologic, morphologic, functional and biochemical parameters. Our analysis was based on a study in 100 consecutive cases.
Evaluation and assessment of the following parameters before and within a 30-day post TIPSS period: portosystemic gradient; morphologic delineation of the portal circulation; invasive scintigraphic determination of the portal perfusion fraction (PPF) and the total liver perfusion (GLP); transcatheter intraarterial flow change measurement; serum levels of albumin and bilirubin; assessment of hepatic encephalopathy by appropriate testing; assessment of recurrent variceal bleeding
by TIPSS variceal filling was widely reduced; as assessed morphologically and rheologically portal liver perfusion was significantly reduced. However, there was immediate onset of compensated liver perfusion by increased arterial inflow. Total liver perfusion was not significantly altered. In TIPSS portal decompression was readily achieved with reduction of the portosystemic gradient from an average of 24 mmHg to 10.5 mmHg. In our series we could not demonstrate an increased incidence of hepatic encephalopathy during the 30-day post TIPSS period. Bilirubin levels were significantly increased after TIPSS from 2.45 to 2.61 mg/dl (p = 0.0067), while albumin levels were not altered. Early mortality was 4% and early re-bleeding rate 3%, respectively.
the concept of TIPSS represents an individually calibrated H-shunt. The significant reduction of post TIPSS portal perfusion appears to be compensated by increased arterial inflow. This is reflected by invasive flow measurement results and by the clinical results. Letality of TIPSS is low.
通过特别参考几个流变学、形态学、功能和生化参数，来演示和记录经颈静脉肝内门体分流术（TIPSS）引起的肝脏灌注模式变化。我们的分析基于对100例连续病例的研究。
在TIPSS术前及术后30天内评估以下参数：门体压力梯度；门静脉循环的形态描绘；门静脉灌注分数（PPF）和全肝灌注（GLP）的侵入性闪烁扫描测定；经导管动脉内血流变化测量；血清白蛋白和胆红素水平；通过适当检测评估肝性脑病；评估复发性静脉曲张出血
通过TIPSS，静脉曲张充盈明显减少；从形态学和流变学评估，门静脉肝灌注显著降低。然而，通过增加动脉流入立即出现了代偿性肝灌注。全肝灌注无显著改变。在TIPSS中，门体减压很容易实现，门体压力梯度从平均24 mmHg降至10.5 mmHg。在我们的系列研究中，未发现TIPSS术后30天内肝性脑病发生率增加。TIPSS术后胆红素水平从2.45 mg/dl显著升至2.61 mg/dl（p = 0.0067），而白蛋白水平未改变。早期死亡率分别为4%，早期再出血率为3%。
TIPSS的概念代表了一种个体化校准的H形分流。TIPSS后门静脉灌注的显著降低似乎通过增加动脉流入得到了补偿。这通过侵入性血流测量结果和临床结果得以体现。TIPSS的致死率较低。
