■经颈静脉肝内门体分流术(TIPS)可缓解Budd-Chiari综合征(BCS)的肝静脉阻塞,但对肝功能的影响尚不清楚,特别是在立即治疗期之外。本研究旨在评估TIPS对BCS患者肝功能和预后的长期影响。
■纳入了1999年至2018年接受TIPS的20例BCS患者。TIPS程序时的人口统计数据和临床数据,6个月,12个月,2年,5年,收集了10年后的TIPS。
■在TIPS时,有13名(13/20,65%)女性和7名(7/20,35%)男性的平均年龄为42.6±12.8岁。从BCS诊断到TIPS的中位时间为41(IQR:4-165)天。严重腹水患者的数量从TIPS时的10/17(58.8%)显着减少,至1/16(7.7%),1/13(7.7%),2/16(12.5%),1/14(7.1%),6个月时为0/8(0%),12个月,2年,TIPS后5年和10年,分别。4/20(20%)患者在TIPS手术后出现了新的肝性脑病。Child-Pugh评分从TIPS前的9.4±1.8分显着下降到6个月时的7.6±1.8分,12个月时7.4±1.5,2年时7.3±1.6,5年时6.8±1.5,TIPS后10年为6.4±0.7。15例(15/20,75%)患者在30天内需要TIPS翻修,其中4例(4/15,26.7%),2(2/15,1个月至1年内13.3%,和9(9/15,60%)在1年以上。8例(8/20,40%)患者在TIPS后7.3(IQR3.2-12.9)年的中位时间接受了肝移植(LT)。
■BCS的TIPS放置可导致症状持续缓解并改善肝功能。尽管经常需要修订,TIPS的长期耐久性可以避免大多数患者对LT的需求。
UNASSIGNED: Transjugular intrahepatic portosystemic shunt (TIPS) relieves hepatic venous obstruction in Budd-Chiari syndrome (BCS), but the effect on liver function is unclear, particularly outside the immediate post-treatment period. This study aims to evaluate the long-term impact of TIPS on liver function and outcomes in BCS patients.
UNASSIGNED: Twenty patients with BCS who underwent TIPS from 1999 to 2018 were included. Demographic data and clinical data at the time of TIPS procedure, 6 months, 12 months, 2 years, 5 years, and 10 years post-TIPS were collected.
UNASSIGNED: There were 13 (13/20, 65%) women and 7 (7/20, 35%) men with a mean age at the time of TIPS of 42.6 ± 12.8 years. The median time from BCS diagnosis to TIPS was 41 (IQR: 4-165) days. The number of patients with severe ascites decreased significantly from 10/17 (58.8%) at the time of TIPS, to 1/16 (7.7%), 1/13 (7.7%), 2/16 (12.5%), 1/14 (7.1%), and 0/8 (0%) at 6 months, 12 months, 2 years, 5 years and 10 years post-TIPS, respectively. 4/20 (20%) patients developed new hepatic encephalopathy post-TIPS procedure. Child-Pugh score significantly decreased from a score of 9.4 ± 1.8 pre-TIPS to 7.6 ± 1.8 at 6 months, 7.4 ± 1.5 at 12 months, 7.3 ± 1.6 at 2 years, 6.8 ± 1.5 at 5 years, and 6.4 ± 0.7 at 10 years post-TIPS. Fifteen (15/20, 75%) patients required TIPS revision including 4 (4/15, 26.7%) within 30 days, 2 (2/15, 13.3% within 1 month to 1 year, and 9 (9/15, 60%) at more than 1 year. Eight (8/20, 40%) patients underwent liver transplantation (LT) at median time of 7.3 (IQR 3.2-12.9) years after TIPS.
UNASSIGNED: TIPS placement for BCS results in sustained resolution of symptoms and improved liver function. Despite the frequent need for revisions, the long-term durability of TIPS can forgo the need for LT in the majority of patients.