PDF(Pubmed)
Abstract：
Ascites in patients with decompensated cirrhosis can lead to abdominal distention and decrease quality of life. Tolvaptan, a vasopressin V2 receptor antagonist, is an effective agent in the treatment of ascites, whereas some patients are refractory to tolvaptan. The efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for these patients is not known. In this study, we performed TIPS for tolvaptan-refractory cirrhotic patients and analysed its efficacy and safety in these patients.
This retrospective analysis included patients with liver cirrhosis who received TIPS for ascites or hydrothorax refractory to tolvaptan therapy along with conventional diuretics between January 2015 and May 2018 at Tokai University Hospital. We evaluated the efficacy and safety of TIPS.
This study included four patients. All patients presented with Child-Pugh class B liver cirrhosis and model for end-stage liver disease-sodium scores were 10/12/14/16. TIPS was generated successfully without any major complications in all patients. The body weight decreased by a mean of 4.7 (SD=1.0) kg and estimated glomerular filtration rate improved from a mean of 38.2 (SD=10.3) to 59.5 (SD=25.0) mL/min/1.73 m2 in a month after TIPS procedure.
TIPS is an effective potential treatment for ascites in patients with tolvaptan refractory condition. In appropriate patients who can tolerate TIPS, the treatment may lead towards renal function improvement.
This retrospective analysis included patients with liver cirrhosis who received TIPS for ascites or hydrothorax refractory to tolvaptan therapy along with conventional diuretics between January 2015 and May 2018 at Tokai University Hospital. We evaluated the efficacy and safety of TIPS.
This study included four patients. All patients presented with Child-Pugh class B liver cirrhosis and model for end-stage liver disease-sodium scores were 10/12/14/16. TIPS was generated successfully without any major complications in all patients. The body weight decreased by a mean of 4.7 (SD=1.0) kg and estimated glomerular filtration rate improved from a mean of 38.2 (SD=10.3) to 59.5 (SD=25.0) mL/min/1.73 m2 in a month after TIPS procedure.
TIPS is an effective potential treatment for ascites in patients with tolvaptan refractory condition. In appropriate patients who can tolerate TIPS, the treatment may lead towards renal function improvement.
摘要：
目的：肝硬化失代偿期患者腹水可导致腹胀和生活质量下降。托伐普坦,加压素V2受体拮抗剂，是治疗腹水的有效药物，而有些患者对托伐普坦无效。经颈静脉肝内门体分流术（TIPS）对这些患者的疗效尚不清楚。在这项研究中,我们对托伐普坦难治性肝硬化患者进行了TIPS,并分析了其在这些患者中的疗效和安全性.
方法：这项回顾性分析包括2015年1月至2018年5月在东海大学医院接受托伐普坦治疗难治性腹水或胸水TIPS以及常规利尿剂治疗的肝硬化患者。我们评估了TIPS的有效性和安全性。
结果：本研究包括4名患者。所有患者出现Child-PughB级肝硬化和终末期肝病模型-钠评分为10/12/14/16。所有患者均成功生成TIPS，无任何重大并发症。TIPS程序后一个月，体重平均减少了4.7（SD=1.0）kg，估计的肾小球滤过率从平均38.2（SD=10.3）提高到59.5（SD=25.0）mL/min/1.73m2。
结论：TIPS是治疗托伐普坦难治性腹水的有效潜在治疗方法。在可以耐受TIPS的适当患者中，治疗可能导致肾功能改善。
方法：这项回顾性分析包括2015年1月至2018年5月在东海大学医院接受托伐普坦治疗难治性腹水或胸水TIPS以及常规利尿剂治疗的肝硬化患者。我们评估了TIPS的有效性和安全性。
结果：本研究包括4名患者。所有患者出现Child-PughB级肝硬化和终末期肝病模型-钠评分为10/12/14/16。所有患者均成功生成TIPS，无任何重大并发症。TIPS程序后一个月，体重平均减少了4.7（SD=1.0）kg，估计的肾小球滤过率从平均38.2（SD=10.3）提高到59.5（SD=25.0）mL/min/1.73m2。
结论：TIPS是治疗托伐普坦难治性腹水的有效潜在治疗方法。在可以耐受TIPS的适当患者中，治疗可能导致肾功能改善。
