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首页> 外文期刊>European journal of gastroenterology and hepatology >Ten years' follow-up of 472 patients following transjugular intrahepatic portosystemic stent-shunt insertion at a single centre.
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Ten years' follow-up of 472 patients following transjugular intrahepatic portosystemic stent-shunt insertion at a single centre.

机译：在单个中心经颈静脉肝内门体支架分流术插入后的472例患者的十年随访。

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BACKGROUND: Transjugular intrahepatic portosystemic stent-shunt (TIPSS) is increasingly used for the management of portal hypertension. We report on 10 years' experience at a single centre. METHODS: Data held in a dedicated database was retrieved on 497 patients referred for TIPSS. The efficacy of TIPSS and its complications were assessed. RESULTS: Most patients were male (59.4%) with alcoholic liver disease (63.6%), and bleeding varices (86.8%). Technical success was achieved in 474 (95.4%) patients. A total of 13.4% of patients bled at portal pressure gradients < or = 12 mmHg, principally from gastric and ectopic varices. Procedure-related mortality was 1.2%. The mean follow-up period of surviving patients was 33.3 +/- 1.9 months. Primary shunt patency rates were 45.4% and 26.0% at 1 and 2 years, respectively, while the overall secondary assisted patency rate was 72.2%. Variceal rebleeding rate was 13.7%, with all episodes occurring within 2 years of TIPSS insertion, and almost all due to shunt dysfunction. The overall mortality rate was 60.4%, mainly resulting from end-stage liver failure (42.5%). Patients who bled from gastric varices had lower mortality than those from oesophageal varices (53.9% versus 61.5%, P < 0.01). The overall rate of hepatic encephalopathy was 29.9% (de novo encephalopathy was 11.5%), with pre-TIPSS encephalopathy being an independent predicting variable. Refractory ascites responded to TIPSS in 72% of cases, although the incidence of encephalopathy was high in this group (36.0%). CONCLUSIONS: TIPSS is effective in the management of variceal bleeding, and has a low complication rate. With surveillance, good patency can be achieved. Careful selection of patients is needed to reduce the encephalopathy rate.
机译：背景：经颈静脉肝内门体支架分流术（TIPSS）越来越多地用于门静脉高压症的治疗。我们报告在一个中心的10年经验。方法：检索了专门数据库中保存的针对TIPSS的497例患者的数据。评估了TIPSS的疗效及其并发症。结果：大多数患者为男性（59.4％），患有酒精性肝病（63.6％），静脉曲张破裂出血（86.8％）。 474名患者（95.4％）获得了技术成功。共有13.4％的患者在门静脉压力梯度≤12 mmHg时出血，主要来自胃和异位静脉曲张。手术相关死亡率为1.2％。存活患者的平均随访时间为33.3 +/- 1.9个月。在1年和2年时，初级分流通畅率分别为45.4％和26.0％，而总体二级辅助通畅率为72.2％。静脉曲张再出血率为13.7％，所有发作均发生在TIPSS植入后2年内，并且几乎全部是由于分流功能障碍所致。总体死亡率为60.4％，主要是由于终末期肝衰竭（42.5％）所致。胃静脉曲张出血的患者的死亡率低于食管静脉曲张的死亡率（53.9％比61.5％，P <0.01）。肝性脑病的总发生率为29.9％（从头脑病为11.5％），而TIPSS前脑病是一个独立的预测变量。尽管该组脑病的发生率很高（36.0％），但顽固性腹水对TIPSS的反应为72％。结论：TIPSS治疗静脉曲张破裂出血有效，并发症发生率低。通过监视，可以实现良好的通畅。需要仔细选择患者以降低脑病发生率。

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