门脉高压早期TIPS治疗对静脉曲张出血预后的影响

作     者：Monescillo A. Martnez-Lagares F. Ruiz-Del-Arbol L. 雒向宁 

作者机构：Digestive Disease Department Hosp. Univ. Insular de Gran Canaria Plaza del Dr. Pasteur s/n 35016 Las Palmas Spain Dr. 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2005年第1卷第2期

页      面：45-46页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：TIPS 静脉曲张出血 门脉高压 肝静脉压力梯度 硬化剂注射 经颈静脉肝内门 急诊内镜 血流动力学 分流术 住院死亡率 

摘      要：Increased portal pressure during variceal bleeding may have an influence on th e treatment failure rate, as well as on short-and long-term survival. However, the usefulness of hepatic hemodynamic measurement during the acute episode has not been prospectively validated, and no information exists about the outcome of hemodynamically defined high-risk patients treated with early portal decompres sion. Hepatic venous pressure gradient (HVPG) measurement was made within the fi rst 24 hours after admission of 116 consecutive patients with cirrhosis with acu te variceal bleeding treated with a single session of sclerotherapy injection du ring urgent endoscopy. Sixty-four patients had an HVPG less than 20 mm Hg (low -risk group), and 52 patients had an HVPG greater than or equal to 20 mm H g (high-risk group). HR patients were randomly allocated into those receiv ing trans jugular intrahepatic portosystemic shunt (TIPS; HR-TIPS group, n = 26 ) within the first 24 hours after admission and those not receiving TIPS (HR-no n-TIPS group). The HR-non-TIPS group had more treatment failures (50%vs. 12 %, P = .0001), transfusional requirements (3.7±2.7 vs. 2.2 ±2.3, P = .002), n eed for intensive care (16%vs. 3%, P .05), and worse actuarial probability o f survival than the LR group. Early TIPS placement reduced treatment failure (12 %, P = .003), in-hospital and 1-year mortality (11%and 31%, respectively; P .05). In conclusion, increased portal pressure estimated by early HVPG measur ement is a main determinant of treatment failure and survival in variceal bleeding, and early TIPS placement reduces treatment failure and mortality in high risk patients defined by hemodyn amic criteria.