TIPS Versus Peritoneovenous Shunt in the Treatment of Medically Intractable Ascites: A Prospective Randomized Trial
TIPS Versus Peritoneovenous Shunt in the Treatment of Medically Intractable Ascites: A Prospective Randomized Trial
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TIPS 与腹膜静脉分流术治疗难治性腹水：一项前瞻性随机试验
DOI：
10.1097/01.sla.0000128309.36393.71
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发表时间：
2004
影响因子：
9
通讯作者：
L. Carey
中科院分区：
文献类型：
--
作者：
Alexander S. Rosemurgy;E. Zervos;Whalen C. Clark;D. Thometz;T. Black;B. Zwiebel;B. Kudryk;L. Grundy;L. Carey
目的：我们进行了一项前瞻性随机临床试验，比较TIPS与腹膜静脉（PV）分流术治疗难治性腹水的疗效和发病率，从而确定这两种分流术的优越性。方法：32例患者前瞻性随机接受TIPS或腹膜静脉分流术（Denver）。所有患者的药物治疗均失败。结果：TIPS与腹膜静脉分流术相比，分流术的中位（平均±SD）持续时间相似：4.4个月（6±6.6个月）与4.0个月（5±4.6个月）。TIPS术后辅助分流通畅时间较长，分别为31.1个月（41±25.9个月）和13.1个月（19±17.3个月）（P < 0.01， Wilcoxon检验）。最终，TIPS术后19%的患者出现不可逆分流闭塞，而腹膜静脉分流术后38%的患者出现不可逆分流闭塞。TIPS术后的生存期为28.7个月（41±28.7个月），腹膜静脉分流术后为16.1个月（28±29.7个月）。腹膜静脉分流术后腹水的控制比TIPS更快（73% vs. 1个月后46%），但TIPS的长期疗效更佳（例如，3年时85% vs. 40%）。结论：TIPS联合腹膜静脉分流术治疗顽固性腹水。术后无腹水是罕见的。PV分流术可以更快地控制腹水，尽管TIPS可以提供更好的长期疗效。在任何一种分流后，都需要许多干预措施来帮助通畅。TIPS后辅助分流通畅较好。用TIPS治疗难治性腹水有早期分流相关死亡率的风险，腹水得到控制后生存期延长。本研究促进了TIPS在内科难治性腹水的应用，如果接受TIPS的患者有短期生存以外的前景。
Objective:We undertook a prospective randomized clinical trial comparing TIPS to peritoneovenous (PV) shunts in the treatment of medically intractable ascites to establish relative efficacy and morbidity, and thereby superiority, between these shunts. Methods:Thirty-two patients were prospectively randomized to undergo TIPS or peritoneovenous (Denver) shunts. All patients had failed medical therapy. Results:After TIPS versus peritoneovenous shunts, median (mean ± SD) duration of shunt patency was similar: 4.4 months (6 ± 6.6 months) versus 4.0 months (5 ± 4.6 months). Assisted shunt patency was longer after TIPS: 31.1 months (41 ± 25.9 months) versus 13.1 months (19 ± 17.3 months) (P < 0.01, Wilcoxon test). Ultimately, after TIPS 19% of patients had irreversible shunt occlusion versus 38% of patients after peritoneovenous shunts. Survival after TIPS was 28.7 months (41 ± 28.7 months) versus 16.1 months (28 ± 29.7 months) after peritoneovenous shunts. Control of ascites was achieved sooner after peritoneovenous shunts than after TIPS (73% vs. 46% after 1 month), but longer-term efficacy favored TIPS (eg, 85% vs. 40% at 3 years). Conclusion:TIPS and peritoneovenous shunts treat medically intractable ascites. Absence of ascites after either is uncommon. PV shunts control ascites sooner, although TIPS provides better long-term efficacy. After either shunt, numerous interventions are required to assist patency. Assisted shunt patency is better after TIPS. Treating medically refractory ascites with TIPS risks early shunt-related mortality for prospects of longer survival with ascites control. This study promotes the application of TIPS for medically intractable ascites if patients undergoing TIPS have prospects beyond short-term survival.