经颈静脉肝内门体分流术(TIPS)和分流手术是门静脉高压症的既定治疗选择,但尚未对肝脾性血吸虫病(HSS)引起的门脉高压患者进行系统评估,一种被忽视的热带病,对流行地区的发病率和死亡率有重大影响。
在这项回顾性研究中,纳入2012-2020年间在德国和意大利的4家三级转诊医院接受血吸虫病所致慢性门静脉高压症治疗的患者.我们总结了介入前的临床数据,指示,干预措施和临床结果的技术方面。
总的来说,纳入13例确诊的HSS患者。11例患者因晚期门脉高压和保守治疗失败而接受TIPS治疗以预防静脉曲张破裂出血。在两名有TIPS禁忌症或技术上不成功的TIPS手术的患者中,进行近端脾肾分流术联合脾切除术。随访期间(平均随访23个月,累计随访时间31例患者年)无出血事件记录.在五名患者中,观察到明显肝性脑病的中度和短暂发作。每个病人,肝功能衰竭,TIPS插入后发生门静脉血栓形成和导管相关性脓毒症。所有并发症都可以很好地控制,并有良好的结果。
在经验丰富的中心,TIPS植入和分流手术是晚期HSS和门脉高压后遗症患者安全有效的治疗选择,但需要仔细选择病人.
Transjugular intrahepatic portosystemic shunt (TIPS) and shunt surgery are established treatment options for portal hypertension, but have not been systematically evaluated in patients with portal hypertension due to hepatosplenic schistosomiasis (HSS), one of the neglected tropical diseases with major impact on morbidity and mortality in endemic areas.
In this retrospective
case study, patients with chronic portal hypertension due to schistosomiasis treated with those therapeutic approaches in four tertiary referral hospitals in Germany and Italy between 2012 and 2020 were included. We have summarized pre-interventional clinical data, indication, technical aspects of the interventions and clinical outcome.
Overall, 13 patients with confirmed HSS were included. 11 patients received TIPS for primary or secondary prophylaxis of variceal bleeding due to advanced portal hypertension and failure of conservative management. In two patients with contraindications for TIPS or technically unsuccessful TIPS procedure, proximal splenorenal shunt surgery in combination with splenectomy was conducted. During follow-up (mean follow-up 23 months, cumulative follow-up time 31 patient years) no bleeding events were documented. In five patients, moderate and transient episodes of overt hepatic encephalopathy were observed. In one patient each, liver failure, portal vein thrombosis and catheter associated sepsis occurred after TIPS insertion. All complications were well manageable and had favorable outcomes.
TIPS implantation and shunt surgery are safe and effective treatment options for patients with advanced HSS and sequelae of portal hypertension in experienced centers, but require careful patient selection.