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首页> 外文期刊>Hepatology international >Rebleeding rates following TIPS for variceal hemorrhage in the Viatorr era: TIPS alone versus TIPS with variceal embolization
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Rebleeding rates following TIPS for variceal hemorrhage in the Viatorr era: TIPS alone versus TIPS with variceal embolization

机译：Viatorr时代TIPS后静脉曲张出血的再出血率：单独使用TIPS对比采用静脉曲张栓塞的TIPS

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PurposeTo compare rebleeding rates following treatment of variceal hemorrhage with TIPS alone versus TIPS with variceal embolization in the covered stent-graft era.MethodsIn this retrospective study, 52 patients (M:F 29:23, median age 52?years) with hepatic cirrhosis and variceal hemorrhage underwent TIPS insertion between 2003 and 2008. Median Child–Pugh and MELD scores were 8.5 and 13.5. Generally, 10-mm diameter TIPS were created using covered stent-grafts (Viatorr; W.L. Gore and Associates, Flagstaff, AZ). A total of 37 patients underwent TIPS alone, while 15 patients underwent TIPS with variceal embolization. The rates of rebleeding and survival were compared.ResultsAll TIPS were technically successful. Median portosystemic pressure gradient reductions were 13 versus 11?mmHg in the embolization and non-embolization groups. There were no statistically significant differences in Child–Pugh and MELD score, or portosystemic pressure gradients between each group. A trend toward increased rebleeding was present in the non-embolization group, where 8/37 (21.6%) patients rebled while 1/15 (6.7%) patients in the TIPS with embolization group rebled (P?=?0.159) during median follow-up periods of 199 and 252?days (P?=?0.374). Rebleeding approached statistical significance among patients with acute hemorrhage, where 8/32 (25%) versus 0/14 (0%) rebled in the non-embolization and embolization groups (P?=?0.055). A trend toward increased bleeding-related mortality was seen in the non-embolization group (P?=?0.120).ConclusionsTIPS alone showed a high incidence of rebleeding in this series, whereas TIPS with variceal embolization resulted in reduced recurrent hemorrhage. The efficacy of embolization during TIPS performed for variceal hemorrhage versus TIPS alone should be further compared with larger prospective randomized trials.
机译：目的比较覆盖式覆膜支架时代单纯TIPS静脉曲张出血与静脉曲张栓塞TIPS的再出血率。方法这项回顾性研究共纳入52例肝硬化和肝硬化（M：F 29:23，中位年龄52岁）的患者。曲张静脉出血于2003年至2008年进行了TIPS插入。Child-Pugh和MELD的中位数分别为8.5和13.5。通常，使用覆盖的覆膜支架（Viatorr; W.L。Gore and Associates，弗拉格斯塔夫，亚利桑那州）制作直径为10毫米的TIPS。共有37例患者单独接受TIPS，而15例患者经静脉曲张栓塞治疗。结果表明所有TIPS在技术上均成功。栓塞组和非栓塞组的中位门静脉压力梯度降低分别为13和11？mmHg。每组之间的Child–Pugh和MELD评分或门体系统压力梯度均无统计学差异。非栓塞组存在再出血的趋势，在栓塞组中，有8/37（21.6％）的患者再出血，而栓塞组的TIPS患者中有1/15（6.7％）的患者在中位随访期间再出血（P≥0.159）。长达199天和252天（P？=？0.374）。在急性出血患者中，再出血的发生率具有统计学意义，其中非栓塞组和栓塞组的再出血率分别为8/32（25％）和0/14（0％）（P≥0.055）。在非栓塞组中观察到了与出血相关的死亡率增加的趋势（P = 0.120）。结论仅TIPS在该系列中显示较高的再出血发生率，而TIPS与静脉曲张栓塞可减少复发性出血。与较大的前瞻性随机试验相比，应将栓塞栓塞术在栓塞术中进行栓塞治疗的疗效与单纯栓塞术的效果进行比较。

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