经颈静脉肝内门体分流术(TIPS)是门脉高压症的既定方法。这项研究是为了调查长期安全性,技术上的成功,和TIPS的通畅,并确定分流功能障碍的危险因素和临床影响。
前瞻性研究了154例接受胃冠状静脉和/或胃短静脉栓塞治疗和TIPS形成的连续患者。后续数据包括技术成功,TIPS的通畅和修订,以及患者的总体生存率。
在研究期间,一级和二级技术成功率分别为98.7%和100%,分别。63例患者出现分流功能障碍,分流狭窄30例,分流闭塞33例。累计60个月的小学,初级辅助,二次通畅率为19.6%,43.0%,和93.4%,分别。TIPS功能障碍组和非功能障碍组的累积60个月总生存率相似(68.6%vs.58.6%,P=.096)。基线门静脉血栓形成(P<.001),裸支架的使用(P=0.018),和门静脉压力梯度(PPG)(P=0.020)是分流功能障碍的独立预测因子,肝细胞癌(P<.001),和腹水(P=0.003)的总生存率。PPG对分流功能障碍的准确性有统计学意义(P<.001),截止值8.5的敏感性为77.8%,特异性为64.8%.
长期安全,技术上的成功,TIPS通畅良好;基线门静脉血栓形成,使用裸露的支架,和PPG与分流功能障碍显著相关;由于二次通畅率高,分流功能障碍对患者长期生存率影响不大.
Transjugular intrahepatic portosystemic shunt (TIPS) is an established method for portal hypertension. This study was to investigate the long-term safety, technical success, and patency of TIPS, and to determine the risk factors and clinical impacts of shunt dysfunction.
A total of 154 consecutive patients undergoing
embolotherapy of gastric coronary vein and/or short gastric vein and TIPS creation were prospectively studied. Follow-up data included technical success, patency and revision of TIPS, and overall survival of patients.
During the study, the primary and secondary technical success rates were 98.7% and 100%, respectively. Sixty-three patients developed shunt dysfunction, 30 with shunt stenosis and 33 with shunt occlusion. The cumulative 60-month primary, primary assisted, and secondary patency rates were 19.6%, 43.0%, and 93.4%, respectively. The cumulative 60-month overall survival rates were similar between the TIPS dysfunction group and the TIPS non-dysfunction group (68.6% vs. 58.6%, P = .096). Baseline portal vein thrombosis (P < .001), use of bare stents (P = .018), and portal pressure gradient (PPG) (P = .020) were independent predictors for shunt dysfunction, hepatocellular carcinoma (P < .001), and ascites (P = .003) for overall survival. The accuracy of PPG for shunt dysfunction was statistically significant (P < .001), and a cutoff value of 8.5 had 77.8% sensitivity and 64.8% specificity.
The long-term safety, technical success, and patency of TIPS were good; baseline portal vein thrombosis, use of bare stents, and PPG were significantly associated with shunt dysfunction; shunt dysfunction has little impact on patients\' long-term survival because of high secondary patency rates.