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中华介入放射学电子杂志 ›› 2015, Vol. 03 ›› Issue (03) : 135 -139. doi: 10.3877/cma.j.issn.2095-5782.2015.03.006

所属专题: 文献

血管介入

应用TIPS技术治疗顽固性腹腔积液的临床疗效分析
赵洪伟1, 刘福全1,(), 岳振东1, 王磊1, 范振华1, 赵孟菲1, 董成宾1, 李志伟2, 余灵祥2   
  1. 1. 100038 首都医科大学附属北京世纪坛医院介入治疗科
    2. 100039 北京,中国人民解放军第三○二医院门静脉高压外科
  • 收稿日期:2014-10-11 出版日期:2015-08-01
  • 通信作者: 刘福全

Short- and long-term effects of the transjugular intrahepatic portosystemic shunt on refractory ascites

Hongwei Zhao1, Fuquan Liu1,(), Zhendong Yue1, Lei Wang1, Zhenhua Fan1, Mengfei Zhao1, Chengbin Dong1, Zhiwei Li2, Lingxiang Yu2   

  1. 1. Department of interventional therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
  • Received:2014-10-11 Published:2015-08-01
  • Corresponding author: Fuquan Liu
  • About author:
    Corresponding author: Liu Fuquan, Email:
引用本文:

赵洪伟, 刘福全, 岳振东, 王磊, 范振华, 赵孟菲, 董成宾, 李志伟, 余灵祥. 应用TIPS技术治疗顽固性腹腔积液的临床疗效分析[J]. 中华介入放射学电子杂志, 2015, 03(03): 135-139.

Hongwei Zhao, Fuquan Liu, Zhendong Yue, Lei Wang, Zhenhua Fan, Mengfei Zhao, Chengbin Dong, Zhiwei Li, Lingxiang Yu. Short- and long-term effects of the transjugular intrahepatic portosystemic shunt on refractory ascites[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2015, 03(03): 135-139.

目的

探讨应用TIPS技术治疗肝硬化门静脉高压症引起的顽固性腹腔积液临床疗效。

方法

对接受TIPS技术治疗成功的肝硬化顽固性胸腹腔积液患者427例进行术前和术后长期随访分析。

结果

手术成功率99.30%(427/430),术后随访胸腹腔积液完全消失85.25%(364/427)、有效8.43%(36/427)、无效6.32%(27/427);术后分流道累积再狭窄率:半年、1年、2年、3年、4年、5年分别为:3.98%(17/427)、18.49%(76/411)、27.39%(103/376)、37.43%(125/334)、46.01%(121/263)、58.54%(120/205);术后生存率:半年、1年、2年、3年、4年、5年分别为:99.53%(425/427)、96.59%(397/411)、87.23%(328/376)、81.14%(271/334)、73.38%(193/263)、57.56%(118/205)。无与手术相关的死亡病例。

结论

TIPS治疗肝硬化门静脉高压顽固性胸腹腔积液安全有效,可作为此类疾患的常规治疗方法,值得临床推广。

Objective

To investigate the clinical efficacy of applicating TIPS treatment of cirrhosis and portal hypertension caused refractory pleural effusion and ascites.

Methods

In the retrospective study, 427 consecutive patients with cirrhosis and portal hypertension caused refractory pleural effusion and ascites who have received TIPS treatment were followed-up and analyzed.

Results

The success rate of TIPS were 99.30% (427/430) and there were 85.25% (364/427) patients whose symptoms of pleural effusion and ascites were completely disappeared post-TIPS, besides 8.43% (36/427) were effective and 6.32% (27/427) were ineffective; Cumulative rate of shunt dysfunction post-TIPS were 3.98% (17/427), 18.49% (76/411), 27.39% (103/376), 37.43% (125/334), 46.01% (121/263) and 58.54% (120/205) respectively in 6 months, 1 year, 2 years, 3 years, 4 years and 5 years; The survival rate were 99.53% (425/427), 96.59% (397/411), 87.23% (328/376), 81.14% (271/334), 73.38% (193/263), 57.56% (118/205) respectively in 6 months, 1 year, 2 years, 3 years, 4 years and 5 years. No deaths associated with TIPS-operation in the study.

Conclusions

TIPS should be considered a safe, effective and conventional therapy for cirrhosis and portal hypertension caused refractory pleural effusion and ascites of such disorders, worthy of promotion.

图1 治疗前腹部CT可见肝脏形态不规则,腹腔和盆腔大量积液
图2 TIPS术中经肝静脉成功穿刺进入门静脉,造影和测压
图3 TIPS术中经肝静脉和门静脉之间建立分流道
图4 术后3个月复查CT可见腹部、盆腔积液消失
1
Tan HK, James PD, Sniderman KW, et al. Long-term clinical outcome of patients with cirrhosis and refractory ascites treated with transjugular intrahepatic portosystemic shunt insertion[J]. J Gastroenterol Hepatol, 2015,30(2):389-395.
2
Rössle M, Ochs A, Gulberg V, et al. A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites[J]. N Engl J Med, 2000,342(23):1701-1707.
3
Gin ès P, Uriz J, Calahorra B, et al. Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis[J]. Gastroenterology, 2002,123(6):1839-1847.
4
Sanyal AJ, Genning C, Reddy KR, et al. The North American Study for the treatment of refractory ascites[J]. Gastroenterology, 2003,124(3):634-641.
5
Salerno F, Merli M, Riggio O, et al. Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosis with severe ascites[J]. Hepatology, 2004,40(3):629-635.
6
Heuman DM, Abou-Assi SG, Habib A, et al. Persistent ascites and low serum sodium identify patients with cirrhosisand low MELD scores who are at high risk for early death[J]. Hepatology, 2004,40(4):802-810.
7
Rössle M, Ochs A, Gülberg V, et al. A comparison of paracentesis and transjugular intrahepatic portosystemic shuntingin patients with ascites[J]. N Engl J Med, 2000,342(23):1701-1707.
8
Lebrec D, Giuily N, Hadengue A, et al. Transjugular intrahepatic portosystemic shunts:comparison with paracentesisin patients with cirrhosis and refractory ascites:a randomizedtrial[J]. J Hepatol, 1996,25(2):135-144.
9
Sanyal AJ, Genning C, Reddy KR, et al. The North American study for the treatment of refractory ascites[J]. Gastroenterology, 2003,124(3):634-641.
10
Salerno F, Merli M, Riggio O, et al. Randomized controlled study of TIPS versus paracentesis plus albumin in cirrhosiswith severe ascites[J]. Hepatology, 2004,40(3):629-635.
11
Saab S, Nieto JM, Ly D, et al. TIPS versus paracentesis forcirrhotic patients with refractory ascites[J]. Cochrane DatabaseSyst Rev,2004,3:CD004889.
12
Deltenre P, Mathurin P, Dharancy S, et al. Transjugular intrahepatic portosystemic shunt in refractory ascites: a meta-analysis[J]. Liver Int, 2005,25(2):349-356.
13
Albillos A, Bañares R, González M, et al. A meta analysis of transjugular intrahepatic portosystemic shunt versus paracentesis for refractory ascites[J]. J Hepatol, 2005,43(6):990-996.
14
D'Amico G, Luca A, Morabito A, et al. Uncover transjugular intrahepatic portosystemic shunt for refractory ascites: ameta-analysis[J]. Gastroenterology, 2005,129(4):1282-1293.
15
Salerno F, Cammà C, Enea M, et al. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data[J]. Gastroenterology, 2007,133(3):825-834.
16
Michl P, Gülberg V, Bilzer M, et al. Transjugular intrahepatic portosystemic shunt for cirrhosis and ascites: effects inpatients with organic or functional renal failure[J]. Scand J Gastroenterol, 2000,35(6):654-657.
17
Bercu ZL, Fischman AM, Kim E, et al. TIPS for refractory ascites: a 6-year single-center experience with expanded polytetrafluoroethylene-covered stent-grafts[J]. AJR Am J Roentgenol, 2015,204(3):654-661.
18
Becq A, Ozenne V, Plessier A, et al. Transjugular intrahepatic portosystemic shunt as bridge-to-surgery in refractory gastric antral vascular ectasia[J]. World J Gastroenterol, 2015,21(18):5749-5750.
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