PDF(Pubmed)
Abstract：
UNASSIGNED: Colorectal surgery in patients with inflammatory bowel disease (IBD) and cirrhosis has increased morbidity, which may preclude surgery. Preoperative transjugular intrahepatic portosystemic shunt (TIPS) is postulated to reduce surgical risk. In this retrospective single-center study, we characterized perioperative outcomes in patients with IBD and cirrhosis who underwent preoperative TIPS.
UNASSIGNED: We identified patients with IBD and cirrhosis who had undergone preoperative TIPS for portal decompression between 2010 and 2023. All other indications for TIPS led to patient exclusion. Demographic and medical data were collected, including portal pressure measurements. Primary outcome of interest was perioperative outcomes.
UNASSIGNED: Ten patients met the inclusion criteria. The most common surgical indications were dysplasia (50%) and refractory IBD (50%). TIPS was performed at a median of 47 days (IQR 34-80) before surgery, with reduction in portal pressures (22.5 vs. 18.5 mmHg, P < .01) and portosystemic gradient (12.5 vs. 5.5 mmHg, P < .01). Perioperative complications occurred in 80% of patients, including surgical site bleeding (30%), wound dehiscence (10%), systemic infection (30%), liver function elevation (50%), and coagulopathy (50%). No patients required re-operation, with median length of stay being 7 days (IQR 5.5-9.3). The 30-day readmission rate was 40%, most commonly for infection (75%), with 2 patients having intra-abdominal abscesses and 1 patient with concern for bowel ischemia. Ninety-day and one-year survival was 100% and 90%, respectively. Patients with primary sclerosing cholangitis (PSC)-cirrhosis were noted to have higher perioperative morbidity and a 30-day readmission rate.
UNASSIGNED: In patients with IBD and cirrhosis, preoperative TIPS facilitated successful surgical intervention despite heightened risk. Nevertheless, significant complications were noted, in particular for patients with PSC-cirrhosis.
UNASSIGNED: We identified patients with IBD and cirrhosis who had undergone preoperative TIPS for portal decompression between 2010 and 2023. All other indications for TIPS led to patient exclusion. Demographic and medical data were collected, including portal pressure measurements. Primary outcome of interest was perioperative outcomes.
UNASSIGNED: Ten patients met the inclusion criteria. The most common surgical indications were dysplasia (50%) and refractory IBD (50%). TIPS was performed at a median of 47 days (IQR 34-80) before surgery, with reduction in portal pressures (22.5 vs. 18.5 mmHg, P < .01) and portosystemic gradient (12.5 vs. 5.5 mmHg, P < .01). Perioperative complications occurred in 80% of patients, including surgical site bleeding (30%), wound dehiscence (10%), systemic infection (30%), liver function elevation (50%), and coagulopathy (50%). No patients required re-operation, with median length of stay being 7 days (IQR 5.5-9.3). The 30-day readmission rate was 40%, most commonly for infection (75%), with 2 patients having intra-abdominal abscesses and 1 patient with concern for bowel ischemia. Ninety-day and one-year survival was 100% and 90%, respectively. Patients with primary sclerosing cholangitis (PSC)-cirrhosis were noted to have higher perioperative morbidity and a 30-day readmission rate.
UNASSIGNED: In patients with IBD and cirrhosis, preoperative TIPS facilitated successful surgical intervention despite heightened risk. Nevertheless, significant complications were noted, in particular for patients with PSC-cirrhosis.
摘要：
■结直肠手术在炎症性肠病（IBD）和肝硬化患者中的发病率增加，这可能会妨碍手术。术前经颈静脉肝内门体分流术（TIPS）被认为可以降低手术风险。在这项回顾性单中心研究中，我们对术前接受TIPS治疗的IBD和肝硬化患者的围手术期结局进行了分析.
■我们确定了IBD和肝硬化患者，这些患者在2010年至2023年之间接受了术前TIPS进行门静脉减压。TIPS的所有其他适应症导致患者排除。收集了人口和医疗数据，包括门静脉压力测量。感兴趣的主要结果是围手术期结果。
■10例患者符合纳入标准。最常见的手术指征是发育不良（50％）和难治性IBD（50％）。在手术前的中位数为47天（IQR34-80）进行TIPS，随着门静脉压力的降低(22.5vs.18.5mmHg,P<.01）和门体系统梯度（12.5vs.5.5mmHg,P<.01)。80%的患者发生围手术期并发症,包括手术部位出血（30%），伤口裂开（10%），全身感染（30%），肝功能升高（50%），和凝血障碍（50％）。没有患者需要再次手术，中位住院时间为7天（IQR5.5-9.3）。30天再入院率为40%,最常见的感染（75％），2例腹内脓肿患者和1例肠缺血患者。90天和1年生存率分别为100%和90%，分别。原发性硬化性胆管炎（PSC）-肝硬化患者的围手术期发病率和30天的再入院率较高。
■在IBD和肝硬化患者中，术前TIPS促进了成功的手术干预,尽管风险增加.然而，注意到明显的并发症，特别是PSC肝硬化患者。
■我们确定了IBD和肝硬化患者，这些患者在2010年至2023年之间接受了术前TIPS进行门静脉减压。TIPS的所有其他适应症导致患者排除。收集了人口和医疗数据，包括门静脉压力测量。感兴趣的主要结果是围手术期结果。
■10例患者符合纳入标准。最常见的手术指征是发育不良（50％）和难治性IBD（50％）。在手术前的中位数为47天（IQR34-80）进行TIPS，随着门静脉压力的降低(22.5vs.18.5mmHg,P<.01）和门体系统梯度（12.5vs.5.5mmHg,P<.01)。80%的患者发生围手术期并发症,包括手术部位出血（30%），伤口裂开（10%），全身感染（30%），肝功能升高（50%），和凝血障碍（50％）。没有患者需要再次手术，中位住院时间为7天（IQR5.5-9.3）。30天再入院率为40%,最常见的感染（75％），2例腹内脓肿患者和1例肠缺血患者。90天和1年生存率分别为100%和90%，分别。原发性硬化性胆管炎（PSC）-肝硬化患者的围手术期发病率和30天的再入院率较高。
■在IBD和肝硬化患者中，术前TIPS促进了成功的手术干预,尽管风险增加.然而，注意到明显的并发症，特别是PSC肝硬化患者。
