Percutaneous transhepatic intrahepatic portosystemic shunt for variceal bleeding: A series of six cases and literature review.
Percutaneous transhepatic intrahepatic portosystemic shunt for variceal bleeding: A series of six cases and literature review.
复制标题
经皮肝穿刺肝内门体分流术治疗静脉曲张出血六例并文献复习
DOI：
10.1016/j.jimed.2020.10.007
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发表时间：
2021-03
影响因子：
--
通讯作者：
Zhu X
中科院分区：
文献类型：
--
作者：
Du H;Zhong B;Zhang P;Wang W;Shen J;Zhang S;Li W;Tang H;Zhou L;Yang W;Zhu X
介绍改良经颈静脉肝内门体分流术（TIPS）和经皮经鞘肝内门体分流术（PTIPS）治疗静脉曲张出血（VB）的病例系列。此外，还对与PTIPS相关的科学文献进行了综述。该回顾性临床病例系列包括6例VB患者，这些患者在内镜下套扎或内镜下注射硬化剂联合血管活性药物治疗失败后接受PTIPS治疗。该治疗于2017年1月至2019年6月在一家机构进行。3例患者的肝右叶或左叶以及门静脉右主干或左主干分支严重萎缩。其余3例患者表现为全肝和门静脉严重萎缩，导致肝裂增宽。采用配对t检验比较PTIPS手术前后门静脉压力梯度的变化。随访期间评估再出血率、治疗效果、并发症和技术成功率。所有6例PTIPS手术均成功进行，未观察到严重的手术相关并发症。在平均22.8（范围，18.0-28.0）个月的随访期间，没有患者发生VB。平均门体压差从术前的28.3 ± 4.3 mmHg降至术后即刻的12.3 ± 2.6 mmHg（P < 0.001）。在随访时，根据West Haven标准，发现一名患者在第一年内发生了三次2级肝性脑病。然而，这在药物治疗后得到解决。当患者的门静脉解剖结构不利于使用经颈静脉入路进行TIPS时，PTIPS可以被认为是VB患者安全、有效的补充手术入路。
To present a case series of modified transjugular intrahepatic portosystemic shunts (TIPS) and percutaneous transhepatic intrahepatic portosystemic shunts (PTIPS) in cirrhotic patients with variceal bleeding (VB). In addition, the scientific literature pertaining to PTIPS was reviewed. This retrospective clinical case series included six cirrhotic patients with VB who were treated with PTIPS after the failure of endoscopic band ligation or endoscopic injection sclerotherapy combined with vasoactive drugs. The treatment was conducted between January 2017 and June 2019 at a single institution. Three patients suffered from severe atrophy of the right or left lobar of the liver as well as the main right or left branch of the portal vein. The remaining three patients showed severe atrophy of the whole liver and portal vein, resulting in widening of the liver fissure. A paired t-test was used to compare the changes in portal pressure gradient between before and after the PTIPS operation. The rebleeding rate, treatment efficacy, complications, and technical success rate were all assessed during follow-up. All six PTIPS procedures were performed successfully, with no severe procedural-related complications observed. None of the patients experienced VB during a mean follow-up of 22.8 (range, 18.0–28.0) months. The mean portosystemic pressure gradient decreased from 28.3 ± 4.3 mmHg pre-procedure to 12.3 ± 2.6 mmHg immediately post-procedure (P < 0.001). At follow-up, one patient was found to have developed grade 2 hepatic encephalopathy thrice during the first year, according to the West Haven criteria. However, this was resolved following medical treatment. When the patient’s portal venous anatomy is unconducive to the performance of TIPS using the transjugular approach, PTIPS can be considered as a safe, effective complementary surgical approach for patients with VB.