{"title":"经颈静脉肝内门体分流治疗难治性腹水与复发性非难治性腹水的临床效果比较。","authors":"Shi-Hua Luo, Hui-Fang Zhang, Wei Liu, Jian-Guo Chu, Jian-Yong Chen","doi":"10.4254/wjh.v17.i2.100451","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Transjugular intrahepatic portosystemic shunt (TIPS) has an important role in the therapy of complications of portal-hypertension-related ascites. Various guidelines now indicate that TIPS is indicated for refractory ascites (RA), but TIPS for recurrent nonrefractory ascites (RNRA) achieved better clinical results.</p><p><strong>Aim: </strong>To compare the clinical outcomes of TIPS for RA and RNRA in patients with complications related to portal hypertension.</p><p><strong>Methods: </strong>There were 863 patients divided into two main categories who underwent TIPS between September 2016 and September 2021. In category 1, patients had ascites without cirrhotic gastrointestinal bleeding. The patients were divided into group A (RNRA, <i>n</i> = 183) and group B (RA, <i>n</i> = 217). In category 2, patients had ascites and cirrhotic gastrointestinal bleeding. The patients were divided into group C (RNRA, <i>n</i> = 328) and group D (RA, <i>n</i> = 135). The clinical outcomes were probability of total hepatic impairment, incidence of hepatic encephalopathy (HE) and mortality.</p><p><strong>Results: </strong>The symptoms of ascites disappeared or were relieved within 1 week in group A compared with group B (<i>P</i> = 0.032), and in group C compared with group D (<i>P</i> = 0.027). By the end of follow-up, there were significant differences in the rate of RA in group A compared with group B (<i>P</i> = 0.016), and in group C compared with group D (<i>P</i> = 0.012). The probability of total hepatic impairment was significantly different in group A compared with group B (<i>P</i> = 0.024), and in group C compared with group D (<i>P</i> = 0.019). The total incidence of HE was significantly different in group A compared with group B (<i>P</i> = 0.008), and in group C compared with group D (<i>P</i> = 0.004). The 6-month, and 1-, 2- and 3-year survival rates were significantly different between groups A and B (all <i>P</i> < 0.05), and between groups C and D (all <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>TIPS has a good therapeutic effect on ascites related to cirrhotic portal hypertension, and early TIPS for RNRA can prolong survival, and prevent progression to RA.</p>","PeriodicalId":23687,"journal":{"name":"World Journal of Hepatology","volume":"17 2","pages":"100451"},"PeriodicalIF":2.5000,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866158/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparison of clinical outcomes of transjugular intrahepatic portosystemic shunt for refractory ascites and recurrent nonrefractory ascites.\",\"authors\":\"Shi-Hua Luo, Hui-Fang Zhang, Wei Liu, Jian-Guo Chu, Jian-Yong Chen\",\"doi\":\"10.4254/wjh.v17.i2.100451\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Transjugular intrahepatic portosystemic shunt (TIPS) has an important role in the therapy of complications of portal-hypertension-related ascites. Various guidelines now indicate that TIPS is indicated for refractory ascites (RA), but TIPS for recurrent nonrefractory ascites (RNRA) achieved better clinical results.</p><p><strong>Aim: </strong>To compare the clinical outcomes of TIPS for RA and RNRA in patients with complications related to portal hypertension.</p><p><strong>Methods: </strong>There were 863 patients divided into two main categories who underwent TIPS between September 2016 and September 2021. In category 1, patients had ascites without cirrhotic gastrointestinal bleeding. The patients were divided into group A (RNRA, <i>n</i> = 183) and group B (RA, <i>n</i> = 217). In category 2, patients had ascites and cirrhotic gastrointestinal bleeding. The patients were divided into group C (RNRA, <i>n</i> = 328) and group D (RA, <i>n</i> = 135). The clinical outcomes were probability of total hepatic impairment, incidence of hepatic encephalopathy (HE) and mortality.</p><p><strong>Results: </strong>The symptoms of ascites disappeared or were relieved within 1 week in group A compared with group B (<i>P</i> = 0.032), and in group C compared with group D (<i>P</i> = 0.027). By the end of follow-up, there were significant differences in the rate of RA in group A compared with group B (<i>P</i> = 0.016), and in group C compared with group D (<i>P</i> = 0.012). The probability of total hepatic impairment was significantly different in group A compared with group B (<i>P</i> = 0.024), and in group C compared with group D (<i>P</i> = 0.019). The total incidence of HE was significantly different in group A compared with group B (<i>P</i> = 0.008), and in group C compared with group D (<i>P</i> = 0.004). The 6-month, and 1-, 2- and 3-year survival rates were significantly different between groups A and B (all <i>P</i> < 0.05), and between groups C and D (all <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>TIPS has a good therapeutic effect on ascites related to cirrhotic portal hypertension, and early TIPS for RNRA can prolong survival, and prevent progression to RA.</p>\",\"PeriodicalId\":23687,\"journal\":{\"name\":\"World Journal of Hepatology\",\"volume\":\"17 2\",\"pages\":\"100451\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-02-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866158/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World Journal of Hepatology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4254/wjh.v17.i2.100451\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Hepatology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4254/wjh.v17.i2.100451","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：经颈静脉肝内门静脉系统分流术（TIPS）在门静脉高压相关腹水并发症的治疗中具有重要作用。目前，各种指南都指出TIPS适用于难治性腹水（RA），但TIPS用于复发性非难治性腹水（RNRA）的临床效果更好。目的：比较TIPS与RNRA治疗门静脉高压症相关并发症的临床疗效。方法：2016年9月至2021年9月期间接受TIPS治疗的863例患者分为两大类。第1类患者有腹水，但无肝硬化消化道出血。将患者分为A组（RNRA, n = 183）和B组（RA, n = 217）。第2类患者有腹水和肝硬化消化道出血。将患者分为C组（RNRA, n = 328）和D组（RA, n = 135）。临床结果为全肝损害概率、肝性脑病（HE）发生率和死亡率。结果：A组与B组比较，1周内腹水症状消失或缓解（P = 0.032）； C组与D组比较，1周内腹水症状消失或缓解（P = 0.027）。随访结束时，A组RA发生率与B组比较差异有统计学意义（P = 0.016）， C组与D组比较差异有统计学意义（P = 0.012）。总肝功能损害发生率A组与B组比较差异有统计学意义（P = 0.024）， C组与D组比较差异有统计学意义（P = 0.019）。A组HE总发生率与B组比较差异有统计学意义（P = 0.008）， C组与D组比较差异有统计学意义（P = 0.004）。A、B组患者6个月、1、2、3年生存率及C、D组患者生存率差异均有统计学意义（P < 0.05）。结论：TIPS对肝硬化门脉高压相关腹水有较好的治疗效果，早期TIPS治疗RNRA可延长生存期，防止RA进展。
Comparison of clinical outcomes of transjugular intrahepatic portosystemic shunt for refractory ascites and recurrent nonrefractory ascites.
Background: Transjugular intrahepatic portosystemic shunt (TIPS) has an important role in the therapy of complications of portal-hypertension-related ascites. Various guidelines now indicate that TIPS is indicated for refractory ascites (RA), but TIPS for recurrent nonrefractory ascites (RNRA) achieved better clinical results.
Aim: To compare the clinical outcomes of TIPS for RA and RNRA in patients with complications related to portal hypertension.
Methods: There were 863 patients divided into two main categories who underwent TIPS between September 2016 and September 2021. In category 1, patients had ascites without cirrhotic gastrointestinal bleeding. The patients were divided into group A (RNRA, n = 183) and group B (RA, n = 217). In category 2, patients had ascites and cirrhotic gastrointestinal bleeding. The patients were divided into group C (RNRA, n = 328) and group D (RA, n = 135). The clinical outcomes were probability of total hepatic impairment, incidence of hepatic encephalopathy (HE) and mortality.
Results: The symptoms of ascites disappeared or were relieved within 1 week in group A compared with group B (P = 0.032), and in group C compared with group D (P = 0.027). By the end of follow-up, there were significant differences in the rate of RA in group A compared with group B (P = 0.016), and in group C compared with group D (P = 0.012). The probability of total hepatic impairment was significantly different in group A compared with group B (P = 0.024), and in group C compared with group D (P = 0.019). The total incidence of HE was significantly different in group A compared with group B (P = 0.008), and in group C compared with group D (P = 0.004). The 6-month, and 1-, 2- and 3-year survival rates were significantly different between groups A and B (all P < 0.05), and between groups C and D (all P < 0.05).
Conclusion: TIPS has a good therapeutic effect on ascites related to cirrhotic portal hypertension, and early TIPS for RNRA can prolong survival, and prevent progression to RA.
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