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Safety and efficacy of transjugular intrahepatic portosystemic shunt combined with palliative treatment in patients with hepatocellular carcinoma 预览
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作者 Shi-Hua Luo Jian-Guo Chu +1 位作者 He Huang Ke-Chun Yao 《世界临床病例杂志》 2019年第13期1599-1610,共12页
BACKGROUND There is a close relationship between cirrhosis and hepatocellular carcinoma (HCC). Transjugular intrahepatic portosystemic shunt (TIPS) has good clinical effect in treating the complication of portal hyper... BACKGROUND There is a close relationship between cirrhosis and hepatocellular carcinoma (HCC). Transjugular intrahepatic portosystemic shunt (TIPS) has good clinical effect in treating the complication of portal hypertension. However, because of the risk of postoperative liver failure, severe complications, and low survival rate for HCC, TIPS is contraindicated in patients with portal hypertension and liver cancer. We studied a large cohort of patients with cirrhosis and HCC who underwent TIPS for recurrent variceal bleeding and/or ascites. AIM To assess the safety, efficacy, and survival rate in patients with HCC who underwent TIPS. METHODS Group A comprised 217 patients with HCC and portal hypertension who underwent the TIPS procedure between 1999 and 2014. After TIPS deployment, these patients received palliative treatment for HCC. Group B comprised a cohort of 136 HCC patients with portal hypertension who did not undergo TIPS placement. Group B received palliative treatment for HCC plus medical therapy for portal hypertension. The clinical outcomes and survival rate were assessed. RESULTS In Group A, the primary technical success rate was 97.69% for TIPS placement,and no severe procedure-related complications of TIPS placement were reported. The control of variceal bleeding (VB) within 1 mo did not differ significantly between the groups (P = 0.261). Absorption of refractory ascites within 1 mo, recurrence of VB, and recurrence of refractory ascites differed significantly between the groups (P = 0.017, 0.023, and 0.009, respectively). By comparison, the rate of hepatic encephalopathy in Group B was lower than that in Group A (P = 0.036). The 1-, 2-, 3-, 4-, and 5-year survival rates were significantly different between Groups A and B (χ^2 = 12.227, P = 0.018;χ^2 = 12.457, P = 0.014;χ^2 = 26.490, P = 0.013;χ^2 = 21.956, P = 0.009, and χ^2 = 24.596, P = 0.006, respectively). The mean survival time was 43.7 mo in Group A and 31.8 mo in Group B. Median survival time was 50.0 mo in Group A and 33.0 mo in Grou 展开更多
关键词 HEPATOCELLULAR carcinoma PORTAL hypertension Transjugular INTRAHEPATIC portosystemic SHUNT Transarterial CHEMOEMBOLIZATION RADIOFREQUENCY ablation
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Temporal trends of cirrhosis associated conditions 预览
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作者 Tomoki Sempokuya Guangxiang Zhang Kazuma Nakagawa 《世界肝病学杂志:英文版(电子版)》 2019年第1期74-85,共12页
AIM To evaluate the national inpatient trends of discharges, mortalities and financial impacts associated with four common conditions of cirrhosis. METHODS The publicly available Healthcare Cost and Utilization Projec... AIM To evaluate the national inpatient trends of discharges, mortalities and financial impacts associated with four common conditions of cirrhosis. METHODS The publicly available Healthcare Cost and Utilization Project National Inpatient Sample database was utilized to examine the temporal trends of total number of discharges, mortalities and inpatient costs related to hospitalization with a primary diagnosis of HC, transjugular intrahepatic portosystemic shunt (TIPS), esophageal varices with bleeding (EV) and spontaneous bacterial peritonitis (SBP) from 2005 to 2014. The ten-year temporal trends were assessed using simple linear regressions and multiple regression analysis. Two-sided P < 0.05 was considered statistically significant. RESULTS From 2005 to 2014, the total number of discharges with cirrhosis-associated complications trended up for HC, SBP and EV (HC by 70% increase, P < 0.0001; SBP by 819% increase, P = 0.0002; EV by 9% increase, P = 0.016), but not for TIPS (P = 0.90). HC related to viral hepatitis showed faster increase by 357%(P < 0.0001) in comparison to HC not related to viral hepatitis by 33 %(P = 0.0006). Overall, in-hospital mortality rates for each condition decreased from 2005 to 2014 (HC by 29% reduction, P = 0.0024; SBP by 26% reduction, P = 0.0038; TIPS by 32% reduction, P = 0.021) except for EV (P = 0.34). After adjustment for inflation, aggregate cost of hospitalization for EV, HC, and SBP significantly increased by 20%, 86%, and 980%, respectively, from 2005 to 2014 (all P < 0.02), while TIPS had trend toward decreasing cost by 3%(P = 0.95). CONCLUSION The number of hospitalizations and costs for some of the cirrhosis-associated conditions increased. However, the inpatient mortality rates for most of these conditions decreased. 展开更多
关键词 CIRRHOSIS Hepatic ENCEPHALOPATHY Spontaneous bacterial PERITONITIS Esophageal VARICES Transjugular INTRAHEPATIC portosystemic SHUNT
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Iodine-125 implantation with transjugular intrahepatic portosystemic shunt for main portal vein tumor thrombus 预览
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作者 Yue Zhang Yi-Fan Wu +6 位作者 Zhen-Dong Yue Hong-Wei Zhao Lei Wang Zhen-Hua Fan Fu-Liang He Tao Wang Fu-Quan Liu 《世界胃肠肿瘤学杂志:英文版(电子版)》 CAS 2019年第4期310-321,共12页
BACKGROUND Main portal vein tumor thrombus (MPVTT), which has a high incidence, is the major complication of terminal liver cancer. The occurrence of MPVTT is always a negative prognostic factor for patients with hepa... BACKGROUND Main portal vein tumor thrombus (MPVTT), which has a high incidence, is the major complication of terminal liver cancer. The occurrence of MPVTT is always a negative prognostic factor for patients with hepatocellular carcinoma (HCC). Therefore, attention should be paid to the treatment of MPVTT and its complications. AIM To evaluate the efficacy of transarterial chemoembolization/transarterial embolization (TACE/TAE)+125I seeds implantation with transjugular intrahepatic portosystemic shunt (TIPS) in treating MPVTT and its complications. METHODS From January 2007 to March 2015, 85 consecutive patients with MPVTT were nonrandomly assigned to undergo treatment with TACE/TAE + TIPS and 125I implantation (TIPS-125I group) or TACE/TAE + TIPS only (TIPS only group) in Beijing Shijitan Hospital, and all clinical data were collected. During 24 mo follow-up, the incidence of overall survival, stent stenosis and symptom recurrence was analyzed to evaluate the efficacy of TIPS-125I.RESULTS During 24 mo follow-up of all patients, we collected data at 6, 12 and 24 mo. The rates of survival were 80%, 45%, and 20%, respectively, in the TIPS-125I group, whereas those in the TIPS only group were 64.4%, 24.4%, and 4.4%, respectively (P < 0.05). The rates of symptom recurrence were 7.5%, 22.5%, and 35%, respectively, in the TIPS-125I group, whereas those in the TIPS only group were 31.1%, 62.2%, and 82.2%(P < 0.05). The rates of stent restenosis were 12.5%, 27.5%, and 42.5%, respectively, in the TIPS-125I group, and 42.2%, 68.9%, and 84.4%, respectively, in the TIPS only group (P < 0.05). TIPS-125I was found to be significantly favorable in treating MPVTT and its complications in patients with HCC. CONCLUSION TACE/TAE+125I combined with TIPS is effective in treating MPVTT and its complications, improving quality of life of patients and reducing mortality. 展开更多
关键词 IODINE-125 Transjugular INTRAHEPATIC portosystemic SHUNT MAIN PORTAL vein tumor THROMBUS Metastasis PORTAL hypertension
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Safety and efficacy of transfemoral intrahepatic portosystemic shunt for portal hypertension: A single-center retrospective study 预览
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作者 Yu Zhang Fu-Quan Liu +4 位作者 Zhen-Dong Yue Hong-Wei Zhao Lei Wang Zhen-Hua Fan Fu-Liang He 《世界临床病例杂志》 2019年第12期1410-1420,共11页
BACKGROUND Transfemoral intrahepatic portosystemic shunt (TFIPS) can be performed to treat portal hypertension. However, few studies have evaluated the safety and efficacy of this technique. AIM To retrospectively eva... BACKGROUND Transfemoral intrahepatic portosystemic shunt (TFIPS) can be performed to treat portal hypertension. However, few studies have evaluated the safety and efficacy of this technique. AIM To retrospectively evaluate the safety and clinical outcomes of TFIPS and compare them with those of typical transjugular intrahepatic portosystemic shunt (TIPS). METHODS This retrospective study was approved by our hospital ethics committee. From November 2012 to November 2015, 19 patients who underwent successful TFIPS placement were included. In addition, 21 patients treated with TIPS during the same period were selected as controls. Data collected included the success rate and complications of TIPS and TFIPS. Continuous data were expressed as the mean ± SD and were compared using the Student’s t test. All categorical data were expressed as count (percentage) and were compared using the χ2 test or Fisher’s exact test. The Kaplan–Meier method was used to calculate cumulative survival rate and survival curves. RESULTS Baseline characteristics were comparable between the two groups. The success rate of TFIPS and TIPS was 95%(19/20) and 100%(21/21), respectively. Effective portal decompression and free antegrade shunt flow was completed in all patients. The portal pressure gradient prior to TIPS and TFIPS placement was 23.91 ± 4.64 mmHg and 22.61 ± 5.39 mmHg, respectively, and it was significantly decreased to 10.85 ± 3.33 mmHg and 10.84 ± 3.33 mmHg after stent placement, respectively. Time–to-event calculated rates of shunt patency at one and two years in the TFIPS and TIPS groups were not statistically different (94.7% vs 95.2% and 94.7% vs 90.5%, respectively). De nova hepatic encephalopathy was 27.5%(11/40) with five patients in the TFIPS group (26.3%) and six patients (28.6%) in the TIPS group experiencing it (P = 0.873). The cumulative survival rates were similar between the two groups: 94.7% and 94.7% at 1 and 2 years, respectively, in the TFIPS group vs 100% and 95.2% at 1 and 2 years, respectively, i 展开更多
关键词 Transjugular intraheptic portosystemic SHUNT TRANSFEMORAL intraheptic portosystemic SHUNT PORTAL HYPERTENSION Variceal BLEEDING
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Segmental intrahepatic cholestasis as a technical complication of the transjugular intrahepatic porto-systemic shunt 预览
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作者 Julian Nikolaus Bucher Marcus Hollenbach +5 位作者 Steffen Strocka Gereon Gaebelein Michael Moche Thorsten Kaiser Michael Bartels Albrecht Hoffmeister 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第43期6430-6439,共10页
BACKGROUND Segmental intrahepatic cholestasis caused by transjugular intrahepatic portosystemic shunt(TIPS)(SIC-T),is a rare complication of this technique and only referred by case reports.Thus,we conducted a systema... BACKGROUND Segmental intrahepatic cholestasis caused by transjugular intrahepatic portosystemic shunt(TIPS)(SIC-T),is a rare complication of this technique and only referred by case reports.Thus,we conducted a systematic,retrospective analysis to provide evidence regarding prevalence and consequences of this TIPS-induced bile duct compression.AIM To assess prevalence and outcome of SIC-T in a large TIPS-cohort.METHODS In this retrospective cohort study,we screened the institutional databases for all consecutive patients that were treated by TIPS-placement or TIPS-revision between January 2005 and August 2013.We analyzed radiologic images for signs of biliary congestion.Cases that were indicative of SIC-T were reviewed by two independent radiologists and additional patient data was collected.Descriptive statistics of patient demographics,indications for TIPS and procedural details were registered.Logistic regression analysis was performed to identify predictors for the development of SIC-T.RESULTS We analyzed 135 cirrhotic patients who underwent TIPS(mean age 55 years,79%male gender).Etiology of cirrhosis was alcohol in most cases and indications for TIPS were mainly refractory ascites and recurrent variceal bleeding.TIPS revision was necessary in 31 patients.We identified 4 cases(2.9%)of SIC-T in direct proximity of the TIPS-stent.Diagnosis was confirmed by CT-scan,MRI or endoscopic retrograde cholangio pancreaticography(ERCP).In two patients TIPS was implanted via the right and in one through the medial hepatic vein.One patient received TIPS-prolongation by multiple revisions.Most patients were asymptomatic but one cholangitic abscess necessitated a transhepatic drain.Logistic regression analysis identified TIPS-placement other than from medial hepatic vein to right portal vein as risk factor(OR 21.0)for SIC-T.CONCLUSION SIC-T ads to(mostly late)complications in the interventional treatment of cirrhotic portal hypertensions and can lead to cholangitic abscesses.Patients,particularly with multiple interventions,s 展开更多
关键词 Transjugular intrahepatic portosystemic shunt Cirrhosis ASCITES Bleeding CHOLESTASIS Biliary congestion
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Incidence of portal vein thrombosis after splenectomy and its influence on transjugular intrahepatic portosystemic shunt stent patency 预览
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作者 Fang Dong Shi-Hua Luo +4 位作者 Li-Juan Zheng Jian-Guo Chu He Huang Xue-Qiang Zhang Ke-Chun Yao 《世界临床病例杂志》 2019年第17期2450-2462,共13页
BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is widely accepted as an alternative to surgery for management of complications of portal hypertension.TIPS has been used to treat portal vein thrombosis... BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is widely accepted as an alternative to surgery for management of complications of portal hypertension.TIPS has been used to treat portal vein thrombosis (PVT) in many centers since the 1990s.Although TIPS has good therapeutic effects on the formation of PVT,the effect of PVT on TIPS stenting has rarely been reported.Patients with splenectomy and pericardial devascu-larization have a high incidence of PVT,which can markedly affect TIPS stent patency and increase the risk of recurrent symptoms associated with shunt stenosis or occlusion.AIM To investigate the incidence of PVT after splenectomy and its influence on the patency rate of TIPS in patients with cirrhosis and portal hypertension.METHODS Four hundred and eighty-six patients with portal hypertension for refractory ascites and/or variceal bleeding who required TIPS placement between January 2010 and January 2016 were included in this retrospective analysis.Patients without prior splenectomy were defined as group A (n = 289) and those with prior splenectomy as group B (n = 197).The incidence of PVT before TIPS was compared between the two groups.After TIPS placement,primary patency rate was compared using Kaplan–Meier analysis at 3,6,9 and 12 mo,and 2 and 3 years.The clinical outcomes were analyzed.RESULTS Before TIPS procedure,the incidence of PVT in group A was lower than in group B (P = 0.003),and TIPS technical success rate in group A was higher than in group B (P = 0.016).The primary patency rate in group A tended to be higher than in group B at 3,6,9 and 12 mo,2 years and 3 years (P = 0.006,P = 0.011,P = 0.023,P = 0.032,P = 0.037 and P = 0.028,respectively).Recurrence of bleeding and ascites rate in group A was lower than in group B at 3 mo (P ≤ 0.001 and P = 0.001),6 mo (P = 0.003 and P = 0.005),9 mo (P = 0.005 and P = 0.012),12 mo (P = 0.008 and P = 0.024),2 years (P = 0.011 and P = 0.018) and 3 years (P = 0.016 and P = 0.017),respectively.During 3-years follow-up,the 1-,2- and 3-yea 展开更多
关键词 PORTAL hypertension Transjugular INTRAHEPATIC portosystemic SHUNT SPLENECTOMY PORTAL vein THROMBOSIS
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Parallel transjugular intrahepatic portosystemic shunt with Viatorr? stents for primary TIPS insufficiency: Case series and review of literature 预览
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作者 Driss Raissi Qian Yu +1 位作者 Michael Nisiewicz Steven Krohmer 《世界肝病学杂志:英文版(电子版)》 2019年第2期217-225,共9页
BACKGROUND Transjugular intrahepatic portosystemic shunts (TIPS) can alleviate complications of portal hypertension such as ascites and variceal bleeding by decreasing the portosystemic gradient. In limited clinical s... BACKGROUND Transjugular intrahepatic portosystemic shunts (TIPS) can alleviate complications of portal hypertension such as ascites and variceal bleeding by decreasing the portosystemic gradient. In limited clinical situations, parallel TIPS may be only solution to alleviate either variceal bleeding or ascites secondary to portal hypertension when the primary TIPS fails to do so. Data specifically addressing the use of this partially polytetrafluoroethylene covered nitinol stent (Viatorr■) is largely lacking despite Viatorr■ being the current gold standard for modern TIPS placement. CASE SUMMARY All three patients had portal hypertension and already had a primary Viatorr■ TIPS placed previously. All patients have undergone failed endoscopy to manage acute variceal bleeding before referral for a parallel stent (PS). PS were placed in patients presenting with recurrent variceal bleeding despite existence of a widely patent primary TIPS. Primary stent patency was verified with either Doppler ultrasound or intra-procedural TIPS stent venography. Doppler ultrasound follow-up imaging demonstrated complete patency of both primary and parallel TIPS. All three patients did well on clinical follow-up of up to six months and no major complications were recorded. A review of existing literature on the role of PS in the management of portal hypertension complications is discussed. There are three case reports of use of primary and PS Viatorr? stents placement, only one of which is in a patient with gastrointestinal variceal bleeding despite a patent primary Viatorr? TIPS. CONCLUSION Viatorr?PS placement in the management of variceal hemorrhage is feasible with promising short term patency and clinical follow-up data. 展开更多
关键词 Transjugular INTRAHEPATIC portosystemic SHUNT PARALLEL stent Portal hypertension VARICES Viatorr? Tandem Double BARREL Case report
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Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt to reduce hepatic encephalopathy 预览
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作者 Shi-Hua Luo Jian-Guo Chu +2 位作者 He Huang Guo-Rui Zhao Ke-Chun Yao 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第9期1088-1099,共12页
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is currently used for the treatment of complications of portal hypertension.The incidence of hepatic encephalopathy(HE)remains a problem in TIPS placement.... BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is currently used for the treatment of complications of portal hypertension.The incidence of hepatic encephalopathy(HE)remains a problem in TIPS placement.It has been reported that the right branch mainly receives superior mesenteric venous blood while the left branch mainly receives blood from the splenic vein.We hypothesized that targeted puncture of the left portal vein would divert the non-nutritive blood from the splenic vein into the TIPS shunt;therefore,targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE.AIM To evaluate the influence of targeted puncture of left branch of portal vein in TIPS on HE.METHODS A retrospective analysis of 1244 patients with portal-hypertension-related complications of refractory ascites or variceal bleeding who underwent TIPS from January 2000 to January 2013 was performed.Patients were divided into group A(targeting left branch of portal vein,n=937)and group B(targeting right branch of portal vein,n=307).TIPS-related HE and clinical outcomes were analyzed.RESULTS The symptoms of ascites and variceal bleeding disappeared within a short time.By the endpoint of follow-up,recurrent bleeding and ascites did not differ significantly between groups A and B(P=0.278,P=0.561,respectively).Incidence of HE differed significantly between groups A and B at 1 mo(14.94%vs 36.80%,χ2=4.839,P=0.028),3 mo(12.48%vs 34.20%,χ2=5.054,P=0.025),6 mo(10.03%vs 32.24%,χ2=6.560,P=0.010),9 mo(9.17%vs 31.27%,χ2=5.357,P=0.021),and 12 mo(8.21%vs 28.01,χ2=3.848,P=0.051).There were no significant differences between groups A and B at 3 years(6.61%vs 7.16%,χ2=1.204,P=0.272)and 5 years(5.01%vs 6.18%,χ2=0.072,P=0.562).The total survival rate did not differ between groups A and B(χ2=0.226,P=0.634,log-rank test).CONCLUSION Targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE but has no direct influence on prognosis of portalhypertension-relat 展开更多
关键词 PORTAL hypertension Transjugular INTRAHEPATIC portosystemic SHUNT PORTAL VEIN branch Hepatic ENCEPHALOPATHY
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Current approaches to the management of patients with cirrhotic ascites 预览
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作者 Dmitry Victorovich Garbuzenko Nikolay Olegovich Arefyev 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第28期3738-3752,共15页
This review describes current approaches to the management of patients with cirrhotic ascites in relation to the severity of its clinical manifestations. The PubMed database, the Google Scholar retrieval system, the C... This review describes current approaches to the management of patients with cirrhotic ascites in relation to the severity of its clinical manifestations. The PubMed database, the Google Scholar retrieval system, the Cochrane Database of Systematic Reviews, and the reference lists from related articles were used to search for relevant publications. Articles corresponding to the aim of the review were selected for 1991-2018 using the keywords:“liver cirrhosis,”“portal hypertension,”“ascites,”“pathogenesis,”“diagnostics,” and “treatment.” Uncomplicated and refractory ascites in patients with cirrhosis were the inclusion criteria. The literature analysis has shown that despite the achievements of modern hepatology, the presence of ascites is associated with poor prognosis and high mortality. The key to successful management of patients with ascites may be the stratification of the risk of an adverse outcome and personalized therapy. Pathogenetically based approach to the choice of pharmacotherapy and optimization of minimally invasive methods of treatment may improve the quality of life and increase the survival rate of this category of patients. 展开更多
关键词 Liver CIRRHOSIS ASCITES DIURETICS Large volume PARACENTESIS Peritoneovenous SHUNTING Transjugular INTRAHEPATIC portosystemic SHUNTING
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Transjugular intrahepatic portosystemic shunt for the prevention of recurrent esophageal variceal bleeding in patients with cavernous transformation of portal vein 预览
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作者 Zhao-Peng Li Sui-Sui Wang +3 位作者 Guang-Chuan Wang Guang-Jun Huang Jing-Qin Cao Chun-Qing Zhang 《国际肝胆胰疾病杂志:英文版》 SCIE CAS CSCD 2018年第6期517-523,共7页
Background:Treatment options for patients with cavernous transformation of portal vein(CTPV)are limited.This study aimed to evaluate the feasibility,efficacy and safety of transjugular intrahepatic portosystemic shunt... Background:Treatment options for patients with cavernous transformation of portal vein(CTPV)are limited.This study aimed to evaluate the feasibility,efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS)to prevent recurrent esophageal variceal bleeding in patients with CTPV.Methods:We retrospectively analyzed 67 consecutive patients undergone TIPS from January 2011 to December 2016.All patients were diagnosed with CTPV.The indication for TIPS was a previous episode of variceal bleeding.The data on recurrent bleeding,stent patency,hepatic encephalopathy and survival were retrieved and analyzed.Results:TIPS procedure was successfully performed in 56 out of 67(83.6%)patients with CTPV.TIPS was performed via a transjugular approach alone(n=15),a combined transjugular/transhepatic approach(n=33)and a combined transjugular/transsplenic approach(n=8).Mean portosystemic pressure gradient(PSG)decreased from 28.09±7.28 mmHg to 17.53±6.12 mmHg after TIPS(P<0.01).The probability of the remaining free recurrent variceal bleeding was 87.0%.The probability of TIPS patency reached 81.5%.Hepatic encephalopathy occurrence was 27.8%,and survival rate was 88.9%until the end of follow-up.Four out of 11 patients who failed TIPS died,and 4 had recurrent bleeding.Conclusions:TIPS should be considered a safe and feasible alternative therapy to prevent recurrent esophageal variceal bleeding in patients with CTPV,and to achieve clinical improvement. 展开更多
关键词 CAVERNOUS transformation PORTAL VEIN Transjugular INTRAHEPATIC portosystemic SHUNT Variceal REBLEEDING PORTAL hypertension
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新西兰兔经颈内静脉与开胸途径心脏电生理参数的比较研究
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作者 吴国栋 金学鑫 +1 位作者 罗迎春 尹德春 《哈尔滨医科大学学报》 CAS 2018年第3期221-225,共5页
目的比较新西兰兔经颈内静脉和开胸行心脏电生理检查所获得的电生理参数,以评价两种途径获取的电生理参数是否存在差异,为不同实验条件选择新西兰兔心脏电生理检查途径提供科学依据。方法健康新西兰兔12只,年龄4~6月,1%戊巴比妥... 目的比较新西兰兔经颈内静脉和开胸行心脏电生理检查所获得的电生理参数,以评价两种途径获取的电生理参数是否存在差异,为不同实验条件选择新西兰兔心脏电生理检查途径提供科学依据。方法健康新西兰兔12只,年龄4~6月,1%戊巴比妥麻醉后给予呼吸机支持。先经右颈内静脉途径插入1.9F小动物电生理导管至右心系统行心脏电生理检查,获取窦房结恢复时间(SNRT),心房有效不应期(AERP),房室结有效不应期(AVERP),心率,房颤诱发率,手术时间,死亡率等指标。后经第三、四肋间开胸暴露右心房,将小动物导管贴靠右心房表面再次行心脏电生理检查,重复检测上述指标,比较各电生理参数在两种检查途径间的差异。结果两只兔因开胸手术误伤肺,关胸后死亡。经颈内静脉和开胸途径分别获得电生理参数,SNRT分别为(309.83±27.20)ms和(315.25±43.75)ms(P=0.650),基础刺激200ms时,AERP分别为(96.33±4.66)ms和(97.00±5.22)ms(P=0.339),AVERP分别为(103.50±5.20)ms和(101.66±3.70)ms(P=0.237),PR间期分别为(62.42±3.46)ms和(62.33±2.74)ms(P=0.927),房颤诱发率无显著差异(6.3%vs8.3%,P=0.586),开胸心率明显慢于经颈内静脉(248±29)次/分VS(224±24)次/分,P=0.001;开胸手术时间明显长于经颈内静脉途径(29.75±5.67)min vs(17.42±3.55)min,P〈0.001;死亡率为0%和12.5%(P=0.478)。除心率和手术时间二者存在显著差异外,其他各指标无显著差异。结论经颈内静脉途径与开胸途径各主要电生理参数比较无差异,但开胸途径耗时长,心率明显减慢,死亡率有增加趋势,研究者可以依实验条件互换两种检查路径交替使用。 展开更多
关键词 电生理检查 颈内静脉 开胸 死亡率
Duodenal variceal bleeding secondary to idiopathic portal hypertension treated with transjugular intra-hepatic portosystemic shunt plus embolization:A case report 预览
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作者 Bu-Shan Xie Jia-Wei Zhong +3 位作者 An-Jiang Wang Zhen-Dong Zhang Xuan Zhu Gui-Hai Guo 《世界临床病例杂志》 2018年第16期1217-1222,共6页
BACKGROUND Duodenal varices are a lesser-known complication with non-cirrhotic portal hypertension.We report a circuitous route from missed diagnosis of duodenal varices to correction.An extremely rare case of duodena... BACKGROUND Duodenal varices are a lesser-known complication with non-cirrhotic portal hypertension.We report a circuitous route from missed diagnosis of duodenal varices to correction.An extremely rare case of duodenal variceal bleeding secondary to idiopathic portal hypertension(IPH)is expounded in this study,which was controlled by transjugular intra-hepatic porto-systemic shunt(TIPS)plus embolization.CASE SUMMARY A 46-year-old woman with anemia for two years was frequently admitted to the local hospital.Upon examination,anemia was attributed to gastrointestinal tract bleeding,which resulted from duodenal variceal bleeding detected by repeated esophagogastroduodenoscopy.At the end of a complete workup,IPH leading to duodenal varices was diagnosed.Portal venography revealed that the remarked duodenal varices originated from the proximal superior mesenteric vein.TIPS plus embolization with coils and Histoacryl was performed to obliterate the rupture of duodenal varices.The anemia resolved,and the duodenal varices completely vanished by 2 mo after the initial operation.CONCLUSION TIPS plus embolization may be more appropriate to treat the bleeding of large duodenal varices. 展开更多
关键词 IDIOPATHIC portal hypertension Anemia DUODENAL variceal bleeding Transjugular intra-hepatic porto-systemic SHUNT EMBOLIZATION Case report
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脐血干细胞肝动脉输注联合经颈内静脉肝内门体分流术在失代偿期肝硬化的临床研究 预览
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作者 李坤 张建娜 +3 位作者 杨宏丽 周祝谦 李桂杰 徐昌青 《中华消化病与影像杂志(电子版)》 2015年第3期8-10,共3页
目的:明确脐血干细胞肝动脉输注联合经颈内静脉肝内门体分流术( TIPS)对失代偿期肝硬化患者的治疗效果。方法回顾性分析50例失代偿期肝硬化患者术前、术后2周、4周ALT、AST、TBIL、前白蛋白变化情况,对比患者术前、术后16周食管胃... 目的:明确脐血干细胞肝动脉输注联合经颈内静脉肝内门体分流术( TIPS)对失代偿期肝硬化患者的治疗效果。方法回顾性分析50例失代偿期肝硬化患者术前、术后2周、4周ALT、AST、TBIL、前白蛋白变化情况,对比患者术前、术后16周食管胃底静脉曲张及CT肝脏体积测定变化情况。结果与术前相比,术后4周患者ALT、AST下降不明显,前白蛋白[(51±28)μg/L vs.(145±72)μg/L,P<0.01]、凝血酶原活动度明显升高[(37.0±10.5)% vs.(61.0±28.4)%,P<0.01],总胆红素变化不明显。联合治疗16周后患者食管胃底静脉曲张情况明显改善,肝脏体积增加[(971.3±307.7)cm3 vs.(1220.4±198.5)cm3,P<0.05]。结论联合治疗可显著增加患者肝脏体积,改善患者肝脏合成功能,降低门脉压力。 展开更多
关键词 肝硬化 脐血干细胞移植 门体分流术 经颈静脉肝内 肝动脉造影
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Transjugular Intrahepatic Portosystemic Shunt Versus Surgical Shunting in the Management of Portal Hypertension
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作者 Long Huang Qing-Sheng Yu Qi Zhang Ju-Da Liu Zhen Wang 《中华医学杂志:英文版》 SCIE CAS CSCD 2015年第6期826-834,共9页
Background: The purpose of this article was to clarify the optimal management concerning transjugular intrahepatic portosystemic shunts (TIPSs) and surgical shunting in treating portal hypertension. Methods: All d... Background: The purpose of this article was to clarify the optimal management concerning transjugular intrahepatic portosystemic shunts (TIPSs) and surgical shunting in treating portal hypertension. Methods: All databases, including CBM, CNKI, WFPD, Medline, EMBASE, PubMed and Cochrane up to February 2014, were searched for randomized controlled trials (RCTs) comparing TIPS with surgical shunting. Four RCTs, which were extracted by two independent investigators and were evaluated in postoperative complications, mortality, 2- and 5-year survival, hospital stay, operating time and hospitalization charges. Results: The morbidity in variceal rehemorrhage was significantly higher in TIPS than in surgical shunts (odds ratio [OR] = 7.45, 95% confidence interval[C/]: (3.93-14.15), P 〈 0.00001), the same outcomes were seen in shunt stenosis (OR = 20.01,95% CI: (6.67-59.99), P 〈 0.000001 ) and in hepatic encephalopathy (OR = 2.50, 95% CI: (1.63-3.84), P 〈 0.0001 ). Significantly better 2-year survival (OR = 0.66; 95% CI: (0.44-0.98), P ~ 0.04) and 5-year survival (OR = 0.44; 95% CI: (0.30-0.66), P 〈 0.00001) were seen in patients undergoing surgical shunting compared with TIPS. Conclusions: Compared with TIPS, postoperative complications and survival after surgical shunting were superior for patients with portal hypertension. Application of surgical shunting was recommended for patients rather than TIPS. 展开更多
关键词 COMPLICATIONS Hypertension Portacaval SHUNT PORTAL Portosystemic SHUNT SURGICAL Survival Rate Transjugular INTRAHEPATIC
肝硬化门静脉高压性出血的防治:从外科到内科 预览 被引量:6
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作者 胡平方 谢渭芬 《胃肠病学》 2014年第2期65-69,共5页
门静脉高压性出血是肝硬化最常见的并发症,其防治手段主要包括外科手术、药物、内镜、介入治疗等.二十世纪八十年代以前,门静脉高压性出血的防治以外科手术为主.近二三十年来,随着药物、内镜、介入等治疗手段的发展,外科分流术和断流术... 门静脉高压性出血是肝硬化最常见的并发症,其防治手段主要包括外科手术、药物、内镜、介入治疗等.二十世纪八十年代以前,门静脉高压性出血的防治以外科手术为主.近二三十年来,随着药物、内镜、介入等治疗手段的发展,外科分流术和断流术的应用逐渐减少,门静脉高压性出血的防治已由外科治疗为主逐渐进入内科治疗为主的时代. 展开更多
关键词 高血压 门静脉 非选择性Β受体阻滞剂 内镜下静脉曲张硬化剂治疗 内镜下静脉曲张套扎术 门体分流术 经颈静脉肝内 治疗
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经颈静脉肝内门体分流术治疗肝硬化门静脉高压症的预后评估 预览
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作者 邹松龙 胥莹 《临床肝胆病杂志》 CAS 北大核心 2019年第1期201-204,共4页
经颈静脉肝内门体分流术(TIPS)是肝硬化门静脉高压症的一项重要治疗手段,但术后肝衰竭、肝性脑病等并发症一定程度限制了TIPS的临床应用。总结了血清学指标、临床指标、评分系统等TIPS术后预后评估的研究进展及临床价值。临床可根据实... 经颈静脉肝内门体分流术(TIPS)是肝硬化门静脉高压症的一项重要治疗手段,但术后肝衰竭、肝性脑病等并发症一定程度限制了TIPS的临床应用。总结了血清学指标、临床指标、评分系统等TIPS术后预后评估的研究进展及临床价值。临床可根据实际情况选择不同指标或进行综合评估,以提高患者的术后生存率。 展开更多
关键词 门体分流术 经颈静脉肝内 肝硬化 高血压 门静脉 预后 综述
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直接性肝内门体静脉分流术治疗门静脉高压现状
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作者 王金森 梁晓宇 +1 位作者 陈岩 白少玄 《中华肝胆外科杂志》 CAS CSCD 北大核心 2019年第1期74-76,共3页
经颈静脉肝内门体静脉分流术(TIPS)是临床上治疗门静脉高压症的常用手术方式,可以有效控制门静脉高压相关并发症,如食管胃底静脉曲张破裂出血等。然而,TIPS存在不能长期保持有效分流道通畅的缺点,例如,多数狭窄或闭塞位于其引流静脉—... 经颈静脉肝内门体静脉分流术(TIPS)是临床上治疗门静脉高压症的常用手术方式,可以有效控制门静脉高压相关并发症,如食管胃底静脉曲张破裂出血等。然而,TIPS存在不能长期保持有效分流道通畅的缺点,例如,多数狭窄或闭塞位于其引流静脉—肝静脉。随着直接性肝内门体静脉分流术(DIPS)在临床的应用,已显示出与传统TIPS手术相比的优势。例如DIPS手术无肝静脉途径的分流通道,避免了肝静脉阻塞,以及辐射剂量减少、手术时间减少和安全性增加等。本文回顾了目前国内外关于TIPS(含DIPS)的文献,简要介绍DIPS的发展历程和目前DIPS的关注点。 展开更多
关键词 高血压 门静脉 门体静脉分流术 经颈静脉肝内 直接性肝内门体静脉分流术
经颈静脉肝内门体分流术治疗土三七致肝窦阻塞综合征的疗效
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作者 宋威 张庆桥 +7 位作者 徐浩 魏宁 刘洪涛 肖晋昌 王文亮 高志康 吕墩涛 庄步强 《中华肝胆外科杂志》 CAS CSCD 北大核心 2019年第6期418-421,共4页
目的探讨经颈静脉肝内门体分流术(TIPS)治疗土三七致肝窦阻塞综合征(SOS)的安全性及疗效。方法回顾性分析2017年2月至2018年6月徐州医科大学附属医院收治的土三七致SOS施行TIPS治疗的9例患者临床资料,男5例,女4例,术前Child-Pugh评分(9.... 目的探讨经颈静脉肝内门体分流术(TIPS)治疗土三七致肝窦阻塞综合征(SOS)的安全性及疗效。方法回顾性分析2017年2月至2018年6月徐州医科大学附属医院收治的土三七致SOS施行TIPS治疗的9例患者临床资料,男5例,女4例,术前Child-Pugh评分(9.5±1.3)分,终末期肝病模型(MELD)评分(12.5±5.0)分。观察患者手术成功率、并发症及临床随访结果。结果9例患者均成功施行了TIPS,门静脉压力梯度由术前(22.4±2.7)mmHg(1mmHg=0.133kPa)降至术后(10.4±3.2)mmHg(P<0.05)。无腹腔内出血、胆汁性腹膜炎等并发症。9例患者随访1~17(7.8±6.0)个月。术后1个月,Child-Pugh评分降至(7.1±1.8)分,与术前评分相比,差异有统计学意义(P<0.05)。MELD评分降至(5.3±4.6)分,与术前评分相比,差异有统计学意义(P<0.05)。至随访终点,彩色多普勒超声及门静脉CT血管造影示9例患者TIPS分流道均通畅,肝淤血情况均缓解。全部患者均存活。结论采用TIPS治疗土三七致SOS安全、有效。 展开更多
关键词 门体分流术 经颈静脉肝内 土三七 肝窦阻塞综合征
血管离断术联合经颈静脉肝内门体分流术对门静脉血流动力及肝肾功能的影响 预览
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作者 周文浩 蒋晓忠 +3 位作者 王昌松 黄斌 赵少勇 朱军 《中华普通外科学文献(电子版)》 2019年第6期450-454,共5页
目的分析腹腔镜贲门-胃底周围血管离断联合经颈静脉肝内门体分流术(TIPS)对肝硬化门静脉高压症效果的影响。方法选择2016年2月至2018年2月宜宾市第二人民医院接受治疗的肝硬化门静脉高压症导致胃底食管静脉曲张患者94例,随机数字表法分... 目的分析腹腔镜贲门-胃底周围血管离断联合经颈静脉肝内门体分流术(TIPS)对肝硬化门静脉高压症效果的影响。方法选择2016年2月至2018年2月宜宾市第二人民医院接受治疗的肝硬化门静脉高压症导致胃底食管静脉曲张患者94例,随机数字表法分成两组,各47例,其中对照组行腹腔镜贲门-胃底周围血管离断术,观察组在对照组基础上行TIPS术,观察两组患者临床疗效、实验室指标以及围手术期门静脉血流动力学。结果 (1)观察组患者总有效率为95.74%(45/47),显著高于对照组的82.98%(39/47),差异有统计学意义(Z=5.173,P=0.005)。(2)术后6个月时,观察组患者脾静脉血流量(SVF)、门体压力梯度、门静脉直径(PVD)、脾静脉内径(SVD)、门静脉血流量(PVF)较术前下降,且显著低于同期对照组水平,而脾静脉流速(SVV)及门静脉流速(PVV)较术前升高,显著高于同期对照组水平(P<0.05)。(3)术后1、6个月时,观察组患者血清尿素水平较术前下降,并显著低于同期对照组水平,而白蛋白(ALB)水平较术前上升,显著高于同期对照组水平,术后1个月观察组患者血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)水平高于术前,但低于对照组,术后6个月观察组ALT及AST水平低于术后1个月和对照组(P<0.05)。(4)术后1、6个月时,观察组患者血清内皮素(ET)、血管紧张素Ⅱ(ATⅡ)及血浆肾素活度(PRA)表达水平较术前下降,且显著低于同期对照组水平,差异有统计学意义(P<0.05)。结论腹腔镜贲门-胃底周围血管离断联合TIPS治疗肝硬化门静脉高压导致的胃底食管静脉曲张,可显著改善患者的肝、肾功能及门静脉血流动力学。 展开更多
关键词 高血压 门静脉 门体分流术 经颈静脉肝内 食管和胃静脉曲张 肝硬化
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双能量CT虚拟单能谱成像技术在TIPS术后支架评估中的应用 预览
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作者 杨帆 曾懿 《中国中西医结合影像学杂志》 2019年第3期266-268,共3页
目的:以常规上腹部CT门静脉期增强扫描图像为对比,探讨双能量CT单能谱成像技术在经颈静脉肝内门体静脉内支架分流术(TIPS)术后支架伪影及图像质量评价方面的应用。方法:21例TIPS术后随访患者行上腹部CT平扫、动脉期及门静脉期扫描。门... 目的:以常规上腹部CT门静脉期增强扫描图像为对比,探讨双能量CT单能谱成像技术在经颈静脉肝内门体静脉内支架分流术(TIPS)术后支架伪影及图像质量评价方面的应用。方法:21例TIPS术后随访患者行上腹部CT平扫、动脉期及门静脉期扫描。门静脉期扫描应用双能量扫描模式,并获得100及140kV2个不同能量的原始数据,重建40~190keV间隔为10keV的共16组虚拟单能谱图像及加权120kV混合能谱图像,以加权120kV混合能谱图像作为常规单源混合能谱门静脉期增强扫描图像。在门静脉期虚拟单能谱图像及加权混合能谱图像上,获得各个支架管腔内的伪影指数、噪声及对比噪声比(CNR)。结果:80keV单能谱图像具有最低噪声及最高CNR,支架腔内伪影指数最低,其噪声及伪影指数低于加权120kV混合能谱图像(均P<0.05),CNR高于120kV混合能谱图像(P<0.05)。结论:与常规120kV混合能谱图像相比,双能量CT虚拟单能谱图像对TIPS支架的显示,可在降低支架伪影的同时提高图像质量,其最佳能谱为80keV。 展开更多
关键词 门体分流术 经颈静脉肝内 支架 放射摄影术 双能扫描投影
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