异位静脉曲张占静脉曲张出血的5%,发生在胃食管区域之外。这篇综述评估了经颈静脉肝内门体分流术(TIPS)用于异位静脉曲张治疗的疗效。通过PubMed进行全面搜索,Scopus,WebofScience,Embase使用相关关键字进行到2023年1月16日。包括病例报告和病例系列,其中少于10例TIPS用于异位静脉曲张治疗。质量评估遵循JoannaBriggs研究所的病例报告清单。这项系统评价评估了43项研究,涉及50例接受TIPS的异位静脉曲张患者。患者的平均年龄为54.3岁,一半是女性,还有两个人怀孕了.酒精性肝病(48%)和丙型肝炎感染(26%)是门脉高压的常见原因。在32%和28%的患者中报告了腹水和脾肿大,分别。直肠,口服,造口静脉曲张出血占62%,16%,22%的病人,分别。异位静脉曲张主要位于十二指肠(28%)和直肠(26%)区域。并发症影响了42%的患者,11例再次出血,7例肝性脑病。平均随访12个月,最后,5人接受了肝脏移植。TIPS后死亡率为18%。尽管有并发症和显著的死亡率,在接受TIPS治疗的近半数异位静脉曲张破裂出血患者中观察到了良好的结局.需要进一步的研究来完善策略并改善患者的预后。
Ectopic varices account for 5% of variceal bleedings and occur outside the gastro-esophageal region. This review evaluates the efficacy of transjugular intrahepatic portosystemic shunt (
TIPS) for ectopic variceal management. A comprehensive search through PubMed, Scopus, Web of Science, and Embase was conducted until January 16, 2023, using relevant keywords.
Case reports and
case series with fewer than 10 patients on
TIPS for ectopic variceal management were included. The quality assessment followed the Joanna Briggs Institute checklist for
case reports. This systematic review evaluated 43 studies involving 50 patients with ectopic varices undergoing
TIPS. Patients had a mean age of 54.3 years, half were female, and two were pregnant. Alcoholic liver disease (48%) and hepatitis C infection (26%) were common causes of portal hypertension. Ascites and splenomegaly were reported in 32% and 28% of the patients, respectively. Rectal, oral, and stomal variceal bleeding accounted for 62%, 16%, and 22% of the patients, respectively. Ectopic varices were mainly located in the duodenum (28%) and rectum (26%) regions. Complications affected 42% of the patients, re-bleeding in eleven and hepatic encephalopathy in seven. The follow-up lasted 12 months on average, and finally, 5 received a liver transplant. Mortality post-
TIPS was 18%. Despite complications and a notable mortality rate, favorable outcomes were observed in almost half of the patients with ectopic variceal bleeding managed with TIPS. Further research is warranted to refine strategies and improve patient outcomes.