Early Use of TIPS in Patients with Cirrhosis and Variceal Bleeding.
Early Use of TIPS in Patients with Cirrhosis and Variceal Bleeding.
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DOI：
10.1056/nejmoa0910102
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发表时间：
2010-06-24
影响因子：
158.5
通讯作者：
Bosch, Jaime
中科院分区：
文献类型：
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作者：
Carlos Garcia-Pagan, Juan;Caca, Karel;Bosch, Jaime
背景资料：Child-Pugh C级或B级肝硬化患者，即使接受了经颈静脉肝内门体分流术（TIPS）的补救治疗，内镜检查发现持续出血的患者也存在治疗失败和预后不良的高风险。本研究评估了早期使用TIPS治疗此类患者的效果。我们在入院后24小时内，将63例接受血管活性药物联合内镜治疗的肝硬化和急性静脉曲张出血患者随机分配至随机分组后72小时内接受聚乙烯覆膜支架治疗（早期TIPS组，32例患者）或继续血管活性药物治疗，3 - 5天后用普萘洛尔或纳多洛尔治疗和长期内镜下结扎带（EBL），如果需要插入TIPS作为补救治疗结果：在中位随访16个月期间，药物治疗组有14例患者发生再出血或出血控制失败，而早期TIPS组只有1例患者发生再出血或出血控制失败（P=0.001）。药物治疗-EBL组1年内未发生该复合终点的精算概率为50%，而早期TIPS组为97%（P
Background: Patients with cirrhosis in Child-Pugh class C or those in class B who have persistent bleeding at endoscopy are at high risk for treatment failure and a poor prognosis, even if they have undergone rescue treatment with a transjugular intrahepatic portosystemic shunt (TIPS). This study evaluated the earlier use of TIPS in such patients.Methods: We randomly assigned, within 24 hours after admission, a total of 63 patients with cirrhosis and acute variceal bleeding who had been treated with vasoactive drugs plus endoscopic therapy to treatment with a polytetrafluoroethylene-covered stent within 72 hours after randomization (early-TIPS group, 32 patients) or continuation of vasoactive-drug therapy, followed after 3 to 5 days by treatment with propranolol or nadolol and long-term endoscopic band ligation (EBL), with insertion of a TIPS if needed as rescue therapy (pharmacotherapy-EBL group, 31 patients).Results: During a median follow-up of 16 months, rebleeding or failure to control bleeding occurred in 14 patients in the pharmacotherapy-EBL group as compared with 1 patient in the early-TIPS group (P=0.001). The 1-year actuarial probability of remaining free of this composite end point was 50% in the pharmacotherapy-EBL group versus 97% in the early-TIPS group (P