共查询到20条相似文献,搜索用时 15 毫秒
1.
Carter PL 《American journal of surgery》2011,202(5):561-564
Introduction
Polytetrafluoroethylene (PTFE)-covered transjugular intrahepatic portosystemic shunt (TIPS) stents purportedly provide superior patency. This study was undertaken to determine whether covered stents provide better long-term patency and outcomes after TIPSs.Methods
Patients with portal hypertension undergoing TIPS at a large teaching hospital from 2001 to 2010 were studied. Median data are presented.Results
Two hundred forty-six patients underwent TIPS; 70 received uncovered stents, and 176 received covered stents. Patients who received uncovered stents had more severely impaired liver function (41% were Child class C cirrhotics). The follow-up was longer with uncovered stents (48 vs 24 months, P < .01). Reinterventions for stenosis were undertaken in 33% with uncovered stents versus 19% with covered stents (P = .01). Shunt dysfunction occurred in 57% with uncovered stents versus 21% covered (P = .05). A deterioration of hepatic function occurred in 31% with uncovered stents versus 30% with covered (P = .32). Survival with uncovered stents was 31 months versus 33 months with covered stents (P = .55, Kaplan-Meier).Conclusions
Covered stents may improve patency but do not mitigate postshunt hepatic dysfunction and do not improve survival. 相似文献2.
S. Young J. Bermudez L. Zhang N. Rostambeigi J. Golzarian 《Diagnostic and interventional imaging》2019,100(5):303-308
Purpose
To compare the outcomes in patients who had transjugular intrahepatic portosystemic shunts (TIPS) placed for hepatic hydrothorax with those who had it placed for refractory ascites.Materials and methods
One hundred and forty-seven patients who underwent TIPS placement for refractory fluid accumulation were included. There were 97 men and 50 women with a mean age of 56.1 ± 9.7 (SD) years (range: 25–81 years). Of those, 32 patients (32/147; 21.8%) had refractory hepatic hydrothorax and 115 (115/147; 78.2%) had refractory ascites. Electronic medical records were reviewed for all patients to determine demographic, procedural related, and outcomes data. Both traditional analysis and a propensity score matching analysis were performed, to account for differences in baseline laboratory values, etiology of cirrhosis, age, and average number of paracenteses/thoracenteses per week. Survival analysis was also performed to compare post-TIPS survival by indication.Results
Differences in response rates, in terms of fluid accumulation reductions, at 1, 3, and 6 months were not significant (P = 0.19, P = 0.33, and P = 0.28, respectively). A successful propensity score matching was made between 24 hepatic hydrothorax and 46 ascites patients. After propensity score matching the response rates at 1, 3, and 6 months remained non-significant (P = 0.3, P = 0.71, and P = 0.78 respectively). No differences in mean overall survival were found between hepatic hydrothorax patients (672 days) and ascites patients (1224 days) (P = 0.15).Conclusion
The clinically relevant outcomes of improvement in fluid accumulation and overall survival do not appear to be significantly different in patients who have TIPS placed for refractory hepatic hydrothorax or and those who have TIPS placed for ascites. 相似文献3.
Cortlandt M. Sellers Nariman Nezami Michael L. Schilsky Hyun S. Kim 《Transplantation reviews (Orlando, Fla.)》2019,33(2):64-71
Liver transplantation is one of the mainstays of treatment for liver failure due to severe chronic liver disease. Bridging therapies, such as placement of a transjugular intrahepatic portosystemic shunt (TIPS), are frequently employed to control complications of portal hypertension such as ascites, hydrothorax, and variceal bleeding, and thereby reduce morbidity in patients awaiting transplant. There is no significant difference seen in either graft survival or patient survival between those receiving TIPS pre-transplant and those who do not, although those receiving TIPS placement on average have a longer waiting time on the transplant waitlist. Locoregional therapies, such as thermal ablation or chemoembolization, can be efficacious in patients with HCC and pre-existing TIPS; however there is a risk for increased adverse events in patients receiving these therapies who have TIPS compared to those who do not. In summary, TIPS is a safe, effective treatment that can be used to ameliorate the complications that are sequelae of portal hypertension. While it does not appear to improve survival post-transplant, TIPS placement pre-transplant may increase survival time to transplant, thus improving overall survival as well as quality of life. 相似文献
4.
目的分析影响TIPS治疗食管胃底静脉曲张出血(EGVB)预后的因素。方法回顾性分析68例接受TIPS治疗的EGVB患者的资料。采用Kaplan-Meier方法计算术后累积生存率,不同患者间生存率比较采用log-rank检验。以Cox回归模型分析影响预后的因素,并以ROC曲线确定其预测经TIPS治疗后EGVB患者预后的最佳截点。结果 TIPS术后患者1、2、3年累积生存率分别为90.7%、82.2%和77.9%。患者年龄、术前血清白蛋白为影响TIPS治疗EGVB的预后因素。ROC曲线分析显示,以患者年龄、术前血清白蛋白评估EGVB患者TIPS术后1年生存预后的AUC分别为0.923(P=0.001)和0.183(P=0.011),年龄67.5岁为最佳截点。年龄≤67.5岁患者术后1年累积生存率明显高于年龄67.5岁者(96.4%vs 64.3%,χ~2=10.785,P=0.001)。结论年龄及术前血清白蛋白是预测TIPS治疗EGVB患者生存情况的独立因素;年龄67.5岁患者预后较差。 相似文献
5.
Timothy P. Kurmis 《ANZ journal of surgery》2009,79(10):745-749
Background: Transjugular intrahepatic portosystemic shunts (TIPS) are utilized for the management of complications of portal hypertension, particularly diuretic‐resistant ascites and recurrent variceal bleeding. It has also been applied in Budd–Chiari syndrome and hepatorenal syndrome. We report the results in a small series, over 9 years, from a single centre, and compare these to those published in the literature. Methods: A retrospective case note review of 20 consecutive TIPS procedures performed at Flinders Medical Centre from January 1997 to December 2005 was completed. All indications were included in the analysis. Underlying liver disease, peri‐procedure complications, relief of symptoms and patient survival were recorded. Data on type of TIPS, shunt patency and method of follow‐up were recorded. Results: Thirty‐six TIPS were performed in 20 subjects. All initial TIPS attempts were successful. Indications were: refractory ascites (18), acute variceal bleeding (12) and hepatorenal syndrome (2). There were no peri‐procedure deaths, however. Ninety‐day mortality was 20%. Outcomes in model of end‐stage liver disease score and biochemical characteristics post‐TIPS were comparable to those reported. Overall, TIPS dysfunction rate was 35% at 1 year. TIPS follow‐up and patency surveillance was an ad hoc combination of Doppler ultrasound and venography. Conclusion: TIPS procedure outcomes in our centre are similar to those reported in the literature from large centres. TIPS patency rates may be improved with regular monitoring and early intervention when stenosis occurs. 相似文献
6.
目的探讨经颈静脉肝内门体分流术(TIPS)后发生分流道失功和肝性脑病的危险因素及预防对策。方法回顾性分析2008年8月至2013年1月南京大学医学院附属鼓楼医院收治的116例肝硬化食管胃底静脉曲张破裂出血(EGVB)患者的临床资料。所有患者接受TIPS治疗,其中使用裸支架39例、血管覆膜支架32例和联合支架45例。记录患者的性别、年龄、肝硬化病因、肝功能CTP分级及评分、既往EGVB治疗史、支架类型、门静脉穿刺部位等资料。随访从TIPS手术当日开始,术后第5天行分流道彩色多普勒超声造影检查,术后1、3、6个月及以后每隔6个月均行分流道彩色多普勒超声造影检查。随访时间截至2013年3月。采用COX回归模型单因素分析筛选影响TIPS术后发生分流道失功和肝性脑病的相关变量,再将单因素分析筛选出的变量进行多因素分析。结果TIPS术后5d至36个月18例患者发生分流道失功。发生分流道失功的患者中,采用裸支架者10例,采用血管覆膜支架和联合支架者各4例。65例患者随访时间〉1年,其中59例在术后1年内分流道保持通畅,术后1年通畅率为90.8%(59/65)。12例患者经再次介入溶栓成功,5例未成功,1例因经济原因未处理,再介入通畅率为95.65%(110/115)。29例患者于TIPS术后1~18个月发生肝性脑病,其中5例发生2次以上肝性脑病,3例进展为肝衰竭,1例死亡。21例患者肝性脑病发生在术后3个月内,8例患者肝性脑病发生在术后4~18个月。26例患者肝性脑病为West—HavenⅠ~Ⅱ级,3例患者为West—HavenⅢ级。单因素分析结果表明:肝功能CTP分级、CTP评分、TBil是TIPS术后发生分流道失功的危险因素(RR=0.314,0.600,0.940,P〈0.05)。年龄、肝功能CTP分级、CTP评分是TIPS术后发生肝性脑病的危险因素(RR=2.798,2.683,1.328,P〈0.05)。多因素分析结果显示:肝功能CTP分级、CTP评分和TBil不是TIPS术后发生分流道失功的独立危险因素(RR=0.762,0.650,0.952,P〉0.05)。年龄及肝功能CTP分级是TIPS术后发生肝性脑病的独立危险因素(RR=2.641,2.510,P〈0.05)。脾切除手术史是TIPS术后短期内发生分流道失功的危险因素(RR=0.168,P〈0.05)。结论肝功能CTP分级、CTP评分、TBil是TIPS术后发生分流道失功的危险因素,年龄及肝功能CTP分级是TIPS术后发生肝性脑病的独立危险因素。脾切除后患者TIPS术后抗凝治疗应得到充分重视。术前积极改善肝功能,强化术后3个月内肝性脑病的预防,脾切除患者术后充分抗凝,对减少TIPS术后并发症,提高患者生命质量有重要意义。 相似文献
7.
目的评估经颈静脉肝内门体静脉分流术(TIPS)治疗肝硬化门静脉高压并发症的安全性和有效性。方法自2013年12月至2014年6月,收集31例接受TIPS治疗的肝硬化门静脉高压症的临床资料。术前均接受肝脏CT增强扫描和血管三维重建,了解肝静脉与门静脉的解剖结构关系,以便确定穿刺门静脉分支的靶点,术中,28例栓塞曲张的食管胃底静脉,28例置入巴德公司的一个裸支架加一个Fluency覆膜支架,2例置入单个Fluency覆膜支架。结果 31例患者中30例TIPS操作成功,其中穿刺门静脉右支26例,穿刺门静脉左支4例,成功率为96.8%(30/31);1例因门静脉海绵样变性未成功;无严重并发症发生,近期止血率为100%。结论 TIPS治疗肝硬化门静脉高压并发症是安全和有效的。 相似文献
8.
9.
10.
Background This study investigated whether the therapeutic efficacy and morbidity of three minimally invasive techniques for varicocele
correction—laparoscopic varicocelectomy (LV), antegrade sclerotherapy (AS), and retrograde embolization (RE)—differed between
children and adults.
Methods During a 10-year period, 356 procedures for varicocele correction, including 122 cases of LV, 108 cases of AS, and 126 cases
of RE, were performed for 314 patients at our institution. Of these patients, 223 were 19 years of age or younger (group 1),
and 133 were older than 19 years (group 2). Diagnosis and postoperative results were established clinically and with the use
of Doppler ultrasonography. The failure rates and complications for each procedure were retrospectively evaluated and compared
between the two age groups.
Results The median follow-up period was 69 months (range, 6–122 months). For 25 patients (19.8%), RE was not feasible for technical
reasons. In both groups, LV had a lower failure rate than AS or RE, but the difference between LV and AS was not significant
in group 1 (7.7(% vs 11.9%; p > 0.5). Also in group 1, AS was associated with fewer complications than LV 1 (4.5% vs 15.4%; p < 0.05). In group 2, LV was significantly more effective in correcting varicoceles than the other two techniques (p < 0.01). In this group, the complication rates for all three procedures did not differ significantly (p > 0.05).
Conclusions In our experience, LV was more effective than AS or RE in correcting varicoceles. For children and adolescents, AS may be
more indicated because of the slightly lower complication rate and similar recurrence rates, as compared with LV, for this
age group. The higher incidence of postoperative hydrocele formation after LV warrants more refined techniques such as the
lymphatic-sparing approach. 相似文献
11.
超声引导下门静脉穿刺导引TIPS联合曲张静脉栓塞治疗肝硬化上消化道出血 总被引:1,自引:0,他引:1
目的探讨超声引导下经皮经肝穿刺门静脉导引TIPS联合食管胃底曲张静脉栓塞术(PTVE)治疗肝硬化上消化道出血的临床价值。方法收集82例肝硬化伴反复上消化道出血患者,对其中47例(病例组)采用超声引导下经皮经肝门静脉穿刺并导引TIPS联合PTVE,对35例(对照组)采用传统TIPS路径联合PTVE。比较2组分流道穿刺次数及时长、PTVE完成时长及手术总时长等指标,分别比较2组手术前后肝脏血管情况。记录2组并发症。结果病例组分流道穿刺次数和时长、手术总时长及术中出血率均低于对照组,而分流道穿刺成功率高于对照组(P均0.05);2组PTVE手术时长差异无统计学意义(P=0.15)。与术前相比,2组术后门静脉及脾静脉内径均缩小;门静脉、脾静脉、肠系膜上静脉及下腔静脉流速均加快,肝动脉流速均减低、RI均增高(P均0.05)。病例组无复发消化道出血病例,对照组3例(3/35,8.57%)复发消化道出血(t=3.15,P0.001)。结论超声引导下门静脉穿刺导引TIPS及PTVE可缩短手术时间、提高手术成功率及降低术后复发消化道出血的风险。 相似文献
12.
Giuseppe Orlando Pierre Goffette re Geubel Jan Lerut 《Transplant international》2005,18(12):1382-1385
Vaginal haemorrhage arising from varices is an exceptional complication of portal hypertension. Two cases successfully treated by transjugular intrahepatic portosystemic stent shunt are presented here. Both these patients previously had a total hysterectomy as did three out of four cases reported in the literature. Clinicians should be aware of 'vaginal bleeding' in the context of both hysterectomy and chronic liver disease in order to adopt the correct diagnostic and therapeutic approach. Definitive treatment can be obtained only if the underlying portal hypertension is adequately taken into consideration. 相似文献
13.
14.
目的 分析微创经皮肾镜取石(PCNL)术后迟发大出血的原因并探讨防治措施,评价介入栓塞止血的疗效.方法 回顾性分析2004-2009年13例PCNL术后迟发出血患者的临床资料.男10例,女3例.平均年龄47(35~68)岁.其中肾内多发结石8例,肾巨大铸型结石5例.患者出现严重肉眼血尿的时间为术后5~40 d.13例血红蛋白<80 g/L,其中6例<60 g/L,分析和总结迟发出血的原因、防治方法及超选择肾动脉造影及栓塞止血治疗的疗效.结果 13例中7例经过绝对卧床休息、止血药物、夹闭肾造瘘管、肾造瘘管球囊压迫牵引等保守治疗10~20 d,出血得到控制;6例经保守治疗无效者行肾动脉造影检查,其中假性动脉瘤4例、动静脉瘘2例,经超选择性栓塞止血治疗1~3 d后血尿逐渐消失.随访3~24个月IVU检查示患肾功能良好.结论 术后迟发性大出血是PCNL严重并发症之一,出血原因为肾穿刺通道的动脉损伤并且形成假性动脉瘤或动静脉瘘,肾动脉造影及超选择肾动脉栓塞是治疗迟发大出血安全有效的方法. 相似文献
15.
目的观察急诊经颈静脉肝内门体分流术(TIPS)治疗肝硬化急性静脉曲张破裂出血的中长期效果。方法回顾性分析75例因肝硬化急性静脉曲张破裂出血经药物和内镜治疗失败而于24 h内接受急诊TIPS患者,对比分流前后门静脉压力梯度(PVPG);术后定期规律随访,检测肝肾功能及凝血功能,统计再出血及肝性脑病(HE)发生率、支架通畅情况及生存情况。结果75例TIPS后均成功止血;分流前PVPG为(24.11±4.97)mmHg,分流后(9.21±2.73)mmHg,较前明显降低(P<0.001)。丙氨酸转氨酶(ALT)和凝血酶原时间(PT)术后1、3个月均较术前升高(P均<0.05),术后6、12个月与术前差异均无统计学意义(P均>0.05);术后1、3、6个月及1年总胆红素(TBIL)、白蛋白(ALB)均高于术前(P均<0.05)。随访期间7例复发出血,12例发生HE,8例支架功能障碍,10例死亡。Kaplan-Meier曲线示术后1、3、6个月生存率均为97.33%,12个月为95.73%,2年为92.31%,3、4年均为90.01%,5年为78.35%。结论急诊TIPS治疗肝硬化急性静脉曲张破裂出血安全、有效,中长期效果较好。 相似文献
16.
Branko Skovrlj Patrick Belton Hekmat Zarzour Sheeraz A Qureshi 《World journal of orthopedics》2015,6(11):996-1005
AIM: To compare minimally invasive (MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion (TLIF) surgeries with respect to length of surgery, estimated blood loss (EBL), neurologic complications, perioperative transfusion, postoperative pain, postoperative narcotic use, and length of stay (LOS).METHODS: A systematic review of previously published studies accessible through PubMed was performed. Only articles in English journals or published with English language translations were included. Level of evidence of the selected articles was assessed. Statistical data was calculated with analysis of variance with P < 0.05 considered statistically significant.RESULTS: A total of 11 pertinent laminectomy studies, 20 direct lateral studies, and 27 TLIF studies were found. For laminectomy, MIS techniques resulted in a significantly longer length of surgery (177.5 min vs 129.0 min, P = 0.04), shorter LOS (4.3 d vs 5.3 d, P = 0.01) and less perioperative pain (visual analog scale: 16 ± 17 vs 34 ± 31, P = 0.04). There is evidence of decreased narcotic use for MIS patients (postoperative intravenous morphine use: 9.3 mg vs 42.8 mg), however this difference is of unknown significance. Direct lateral approaches have insufficient comparative data to establish relative perioperative outcomes. MIS TLIF had superior EBL (352 mL vs 580 mL, P < 0.0001) and LOS (7.7 d vs 10.4 d, P < 0.0001) and limited data to suggest lower perioperative pain.CONCLUSION: Based on perioperative outcomes data, MIS approach is superior to open approach for TLIF. For laminectomy, MIS and open approaches can be chosen based on surgeon preference. For lateral approaches, there is insufficient evidence to find non-inferior perioperative outcomes at this time. 相似文献
17.
PURPOSE OF REVIEW: This article discusses the various grafts or biomaterials, minimally invasive techniques, and recent advances for the treatment of female stress urinary incontinence and pelvic organ prolapse. RECENT FINDINGS: The studies reviewed in this paper compared certain biologic grafts to synthetic grafts in clinical trials and histopathological studies. Data from long-term outcome studies for tension-free vaginal tape are evaluated. As tension-free vaginal tape is the foremost technique for stress urinary incontinence correction, many of the newer modalities such as transobturator tape and laparoscopy are compared with it. Immediate and long-term complications from mesh use in stress urinary incontinence and pelvic organ prolapse repair are examined. Correction of prolapse may eventually entail the use of specially designed 'kits' that allow total pelvic floor reconstruction with a single piece of mesh. SUMMARY: Although biological grafts are initially efficacious, the trend is to use synthetic grafts in repair of stress urinary incontinence and pelvic organ prolapse. Midurethral slings continue to be the front-line therapeutic modality for stress urinary incontinence. After analysis of long-term data, other surgical techniques may gain popularity. With increasing use of synthetic grafts, however, long-term complications such as de-novo urgency, erosion, and dyspareunia need to be assessed. 相似文献
18.
19.
20.