门体分流术(TIPS)治疗复杂门静脉高压症的选择

Q4 Medicine
Y. Khoronko, N. Sapronova, E. V. Kosovtsev, E. Khoronko, R. N. Kantsurov, I. Ashimov
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引用次数: 2

摘要

目标通过明智地选择最佳TIPS(经颈静脉肝内门体分流术)变体,改善肝硬化门静脉高压危及生命的并发症患者的治疗效果。材料和方法。共有234名肝硬化门静脉高压并发症患者接受了TIPS植入术。分流放置的适应症包括食道和胃静脉曲张,表现出出血迹象或有再出血风险(172例患者)、顽固性腹水(57例患者),以及肝硬化情况下的门静脉血栓形成(5例患者)。第1组的患者接受了分流放置,同时对食管和胃静脉曲张的流入通路进行了栓塞。在第2组中,优先考虑围手术期治疗,而只有在严重静脉曲张的情况下,才将分流放置与栓塞一起使用。在第3组中,分流放置阶段与门静脉血流恢复相结合。根据并发症、死亡率和生存率对近期和晚期结果进行了研究。后果最长观察期为140个月(11.7年)。所有患者的TIPS疗效均通过门体压力梯度的统计学显著降低得到证实。在第1组中,仅接受分流置入术的患者与再出血相关的死亡率最高(30.6%),而静脉曲张流入途径先栓塞后接受肝内分流置入术患者的死亡率最低(7.1%)。第2组患者腹水和静脉曲张严重程度均有所减轻。通过经验积累和术前计划,依靠对计算机脾门造影数据的仔细解释,TIPS在门静脉血栓形成中的技术可行性得到了增强。结论将TIPS治疗静脉曲张破裂出血的分流放置阶段与选择性栓塞所有经放射学检测的胃食管静脉曲张流入途径相结合是合理的。如果门静脉血栓形成不伴有海绵状变,TIPS可以在恢复门静脉血流的情况下实现有效的门静脉减压。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Selection of a portosystemic shunt placement procedure (TIPS) in the treatment of complicated portal hypertension
Aim. To improve treatment results in patients with the life-threatening complications of cirrhotic portal hypertension by making an informed choice of the optimal TIPS (transjugular intrahepatic portosystemic shunt) variant.Materials and methods. A total of 234 patients suffering from the complications of cirrhotic portal hypertension underwent TIPS placement. The indications for shunt placement include esophageal and gastric varices exhibiting the signs of bleeding or carrying the risk of rebleeding (in 172 patients), refractory ascites (in 57 patients), and portal vein thrombosis in the setting of cirrhosis (in 5 patients). Patients from Group 1 underwent shunt placement together with the embolization of inflow pathways to esophageal and gastric varices. In Group 2, priority was given to perioperative therapy, while shunt placement was used together with embolization only in cases of severe varices. In Group 3, the shunt placement stage was combined with the portal blood flow restoration. Immediate and late results were studied in terms of complications, as well as mortality rate and survival rates.Results. The maximum observation duration amounted to 140 months (11.7 years). TIPS efficacy in all patients was confirmed by a statistically significant decrease in the portosystemic pressure gradient. In Group 1, the highest mortality rate associated with rebleeding was observed in patients who had undergone only shunt placement (30.6%), while the lowest rate was noted in patients whose inflow pathways to varices had first been embolized and who then had undergone intrahepatic shunt placement (7.1%). Patients in Group 2 exhibited a reduction in ascites and the severity of varices. The technical feasibility of TIPS in the setting of portal vein thrombosis was enhanced by experience accumulation and preoperative planning relying on careful interpretation of computed splenoportography data.Conclusion. It is reasonable to combine the shunt placement stage of TIPS for variceal bleeding with selective embolization of all radiologically detected inflow pathways to gastroesophageal varices. If the portal vein thrombosis is not accompanied by cavernous transformation, TIPS can achieve effective portal decompression provided the portal blood flow is restored.
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来源期刊
Annals of HPB Surgery
Annals of HPB Surgery Medicine-Gastroenterology
CiteScore
0.70
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