Transjugular intrahepatic portosystemic stent-shunt (TIPSS) for variceal haemorrhage: initial results in 28 patients

Background: Endoscopic sclerotherapy is an effective form of treatment of bleeding varices in patients with cirrhosis. However, the mortality in patients who rebleed is high. Recently, trans-jugular intrahepatic portosystemic stent-shunt (TIPSS) has been developed as an alternative to surgical shunt formation in patients who have failed sclerotherapy.
Aim: To review the early experience with TIPSS at a teaching hospital.
Methods: Twenty-eight patients underwent TIPSS on 30 occasions between September 1991 and June 1993 for bleeding oesophageal or gastric varices. The majority had alcoholic liver disease.
Results: TIPSS was performed successfully in all patients. Immediate control of bleeding was achieved, but one patient rebled within 24 hours. Complications related to the procedure occurred in 30%, but no patient died from these. Thirty-day mortality was 11% (three of 28), two patients dying from progressive liver failure and one from sepsis. A further three patients died from six weeks to two months following TIPSS, due to liver failure in one, spontaneous bacterial peritonitis in the second and in the third after a fall. This represents an overall mortality of 21%. Three patients have rebled at mean follow-up of 11.3 months. One of these had repeat TIPSS while the other two had balloon dilatation of the stent with control of bleeding. Four patients developed mild chronic encephalopathy which was readily controlled with medical therapy.
Conclusions: TIPSS is an effective means for control of bleeding from oesophageal and/or gastric varices not responding to other methods. Further follow-up is required with regard to rates of rebleeding, encephalopathy and survival.     

经颈静脉肝内门-体静脉分流术同时行胃冠状静脉及胃短静脉栓塞术治疗肝硬化门脉高压并消化道出血

目的评价经颈静脉肝内门-体静脉分流术同时行胃冠状静脉及胃短静脉栓塞术治疗肝硬化门脉高压并消化道出血的效果。资料与方法对81例肝硬化门脉高压并消化道出血患者应用经颈静脉肝内门-体静脉分流术同时行胃冠状静脉及胃短静脉栓塞术进行治疗，其中男61例，女20例，年龄32-74岁。所有患者均有1-3次消化道出血史，合并脾大及脾功能亢进者58例，有腹水者30例。门静脉穿刺成功后首先行脾静脉造影，以明确胃冠状静脉、胃短静脉的部位及曲张情况，将5F Cobra导管超选入胃冠状静脉，注入5％鱼肝油酸钠进行栓塞，对曲张静脉直径较大的不锈钢圈加强栓塞以防再通。如胃短静脉参与构成胃底静脉的曲张一并栓塞，然后建立TIPSS分流道。为评价此项治疗与单纯行分流术对控制再发出血的疗效，笔者随机抽取资料完整的、单纯行分流术的64例患者作为对照组进行研究。结果81例技术操作全部成功，均达到止血效果，无严重并发症。随访1～12个月有51人次来我院行上消化道造影，造影可见食管胃底静脉曲张明显减轻。术后10个月内有7例发生分流道狭窄，并再次发生少量消化道出血(7／81，占8．6％)，对照组再发消化道出血10例(10／64，占15．6％)。结论经颈静脉肝内门-体静脉分流术同时行胃冠状静脉及胃短静脉栓塞，即分流加断流术能获得较好的止血效果，其再发出血率明显低于单纯行分流术组，是治疗门脉高压并消化道出血最合理的介入治疗方法。     

Ease of use and patient preference injection simulation study comparing two prefilled insulin pens

ABSTRACT

This article provides an editorial commentary to accompany the publication of an article on the economic evaluation of vasoactive agents used in the United Kingdom for acute bleeding oesophageal varices in patients with cirrhosis by Wechowski et al. From a clinical standpoint, the successful management of bleeding oesophageal varices should be based on definitive treatments such as therapeutic endoscopy or transjugular intrahepatic portosystemic stent shunt (TIPSS).

Vasoactive agents such as terlipressin can be useful and potentially cost-effective additional therapy, however, particularly in patients where endoscopic treatment is likely to be delayed or is contraindicated.     

经颈内静脉肝内门体分流术并胃冠状静脉栓塞术治疗门脉高压症疗效的超声评价

目的探讨经颈内静脉肝内门体分流术(TIPSS)并胃冠状静脉栓塞术(GCVE)治疗肝硬化门静脉高压症的临床疗效.方法用彩色多普勒超声对13例行TIPSS并GCVE的门静脉高压患者进行血流动力学及腹水情况的跟踪观察.结果13例随访12个月以上,平均(14.0±1.5)个月,13例首次置管全部成功,1例7个月后因分流道狭窄、上消化道出血再次入院,分流道通畅率92.31%(12/13).结论TIPSS并GCVE联合运用能有效治疗门静脉高压症所致上消化道出血和腹水.     

TIPSS治疗门脉高压症的护理

我院自2004年以来开展经颈静脉肝内门腔静脉内支架分流术(transjugular intrahepatic portosystemic stent shunt,TIPSS),取得满意疗效,现将护理体会报告如下.     

CT 和MR三维血管成像技术对于TIPSS的价值

目的 探讨CT血管造影及MR血管造影对门脉高压患者TIPSS治疗的价值。方法 TIPSS术前10例患者进行了三维MR血管造影，2例用MR团注技术测量门脉血流速度。60例进行了三维CT血管造影。所有病例经临床和DSA证实为肝硬化门脉高压，其中，68例行TIPSS治疗。MR血管造影使用西门子1．5T MR机，CT血管造影使用GE High Speed CT／i扫描机。结果 MR血管造影：10例患者均可见门静脉主干及其肝内分支扩张，但其中2例有布加综合征的表现。3例患者可见侧支循环及静脉曲张，表现为胃左静脉丛和左肾静脉曲张、脾肾分流。应用MR“团块追踪”技术测量了2例门脉主干的血流速度，分别为11．8cm／s和10．6cm/s。CT血管造影：准确地显示了60例患者的肝动静脉解剖、门脉主干扩张及其小血管分支，以及19例侧支循环及曲张血管。结论 CT血管造影和MR血管造影是一种无创性的检查方法，可充分显示肝静脉和门静脉解剖及变异，为TIPSS术前提供了重要信息。CT血管造影的空间分辨率优于MR血管造影。     

TIPSS治疗肝硬化门脉高压的应用解剖研究

目的：观察３４个正常人离体肝脏标本的肝、门静脉主支的立体空间关系,为建立肝、门静脉内支架分流提供解剖学依据。材料与方法：３４个新鲜离体肝脏标本（剥制标本３０个,铸型４个）,并与１０例肝硬化的肝,门静脉ＤＳＡ影像学资料进行对照分析。