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A comprehensive review of prognostic scoring systems to predict survival after transjugular intrahepatic portosystemic shunt placement

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Portal Hypertension & Cirrhosis 2022年第2期1卷 133-144页

作者： chongtu yang Bin Xiong Department of Radiology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina Hubei Province Key Laboratory of Molecular Imaging WuhanChina

Patient prognosis after transjugular intrahepatic portosystemic shunt(TIPS)placement is relatively poor and highly heterogeneous;therefore,a prognostic scoring system is essential for survival prediction and risk stratification.Conventional scores include the Child–Turcotte–Pugh(CTP)and model for end‐stage liver disease(MELD)scores.The CTP score was created empirically and displayed a high correlation with post‐TIPS survival.However,the inclusion of subjective parameters and the use of discrete cut‐offs limit its utility.The advantages of the MELD score include its statistical validation and objective and readily available predictors that contribute to its broad application in clinical practice to predict post‐TIPS outcomes.In addition,multiple modifications of the MELD score,by incorporating additional predictors(e.g.,MELD‐Sodium and MELD‐Sarcopenia scores),adjusting coefficients(recalibrated MELD score),or combined(MELD 3.0),have been proposed to improve the prognostic ability of the standard MELD score.Despite several updates to conventional scores,a prognostic score has been proposed(based on contemporary data)specifically for outcome prediction after TIPS placement.However,this novel score(the Freiburg index of post‐TIPS survival,FIPS)exhibited inconsistent discrimination in external validation studies,and its superiority over conventional scores remains undetermined.Additionally,several tools display potential for application in specific TIPS indications(e.g.,bilirubin‐platelet grade for refractory ascites),and biomarkers of systemic inflammation,nutritional status,liver disease progression,and cardiac decompensation may provide additional value,but require further validation.Future studies should consider the effect of TIPS placement when exploring predictors,as TIPS is a pathophysiological approach that substantially alters systemic hemodynamics and ameliorates bacterial translocation and malnutrition.

关键词： Child–Turcotte–Pugh(CTP)score Freiburg index of post‐TIPS survival(FIPS) model for endstage liver disease score(MELD) portal hypertension prognosis transjugular intrahepatic portosystemic shunt

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Dynamic changes in liver function after transjugular intrahepatic portosystemic shunt in patients with cirrhosis

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Journal of Interventional Medicine 2022年第4期5卷 207-212页

作者： Chaoyang Wang Jinghong Yao Huanzhang Niu chongtu yang Jiacheng Liu Yaowei Bai Shuguang Ju Bin Xiong Department of Radiology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China Hubei Province Key Laboratory of Molecular Imaging Wuhan430022China Department of Infectious Disease Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China Department of Interventional Radiology The First Affiliated Hospital of Henan University of Science and TechnologyLuoyang471000China Department of Interventional Radiology The First Affiliated Hospital of Guangzhou Medical UniversityGuangzhou510000China

Purpose:To evaluate the dynamic changes in liver function after transjugular intrahepatic portosystemic shunt(TIPS)creation in patients with cirrhosis and to explore its association with clinical outcomes.Methods:This retrospective study included patients who underwent TIPS between August 2016 and December2020.Liver function was primarily evaluated using the model for end-stage liver disease(MELD)score,which was analyzed at baseline,1 week,1 month,3 months,6 months,and 12 months using one-way repeated measures ANOVA.The Kaplan-Meier method,log-rank test,and multivariate analysis were used as appropriate.Results:In total,235 patients were included in this study.The MELD score was significantly higher at 1 week(11.8±3.1 vs 13.5±3.5,p0.05).At 12 months,the MELD score was higher than the baseline level(11.8±3.1 vs 12.4±3.2,p<0.05).Patients with a recovery of the MELD score(n=151)at 3 months had a lower probability of overt and severe HE(log-rank p=0.015 and p=0.027,respectively)than those without recovery(n=84).Logistic regression analysis revealed that albumin(odds ratio[OR],0.926;95%confidence interval[CI],0.863–0.992;p=0.029)and platelet count(OR,0.993;95%CI,0.987–0.999;p=0.033)were independent predictive factors for non-recovery of the MELD score at 3 months.Conclusions:Liver function after TIPS creation showed a trend of deterioration at first,followed by recovery.Recovery of liver function at three months was associated with reduced overt and severe HE.

关键词： Transjugular intrahepatic portosystemic shunt Liver function Cirrhosis Model for end-stage liver disease

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Management of traumatic peripheral artery pseudoaneurysm:A 10-year experience at a single center

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Journal of Interventional Medicine 2023年第1期6卷 29-34页

作者： Yingliang Wang Hai Zheng Wei Yao Shuguang Ju Yaowei Bai Chaoyang Wang Chen Zhou Jiacheng Liu chongtu yang Songjiang Huang Tongqiang Li yang Chen Bin Xiong Department of Radiology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China Hubei Key Laboratory of Molecular Imaging Wuhan430022China Department of Emergency Surgery Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China Department of Interventional Radiology The First Affiliated Hospital of Guangzhou Medical UniversityGuangzhou 510120China

Purpose: This study aimed to report our 10-year experience with the management of iatrogenic(penetrating trauma) and traumatic(blunt or penetrating trauma) peripheral artery pseudoaneurysms, based on data from a tertiary referral center.Methods: From January 2012 to December 2021, the medical records of consecutive patients with iatrogenic and traumatic peripheral artery pseudoaneurysms were retrospectively reviewed. Patient demographics, clinical features, imaging data, treatment details, and follow-up results were analyzed.Results: Sixty-one consecutive patients were included in this study;48(79%) were men and 13(21%) women,with a mean age of 49.4 ± 13.4 years(range 24–73 years). There were 42 patients(69%) who underwent open surgery, 18(29%) undergoing endovascular embolization or stent implantation, and one(2%) undergoing ultrasound-guided thrombin injection. All patients successfully underwent open or interventional treatment. The median follow-up was 46.8 months(2.5–117.9 months), and the overall reintervention rate was 10%. Of these,one(5%) patient in the interventional treatment group and five(12%) patients in the open surgery group underwent reintervention. The overall complication rate was 8%, with complications occurring only in the open surgery group. No deaths occurred in the peri-operative period. No late complications, such as thrombosis or pseudoaneurysm recurrence, were observed.Conclusion: Peripheral artery pseudoaneurysms arising from iatrogenic or traumatic causes can be effectively treated by both open surgery and interventional procedures in selected patients with acceptable mid-and long-term outcomes.

关键词： Pseudoaneurysm Trauma Peripheral artery Interventional therapy Stent

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A new choice of stent for transjugular intrahepatic portosystemic shunt creation: Viabahn ePTFE covered stent/bare metal stent combination

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Journal of Interventional Medicine 2021年第1期4卷 32-38页

作者： Jiacheng Liu Jie Meng Chen Zhou Qin Shi chongtu yang Jinqiang Ma Manman Chen Bin Xiong Department of Radiology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China Hubei Province Key Laboratory of Molecular Imaging Wuhan430022China

Objectives:To compare the clinical outcomes in terms of structure and function between the insertion of a transjugular intrahepatic portosystemic shunt(TIPS) created with the Viabahn ePTFE covered stent/bare metal stent(BMS) combination and the Fluency ePTFE covered stent/BMS combination.Methods:A total of 101 consecutive patients who received a TIPS from February 2016 to August 2018 in our center were retrospectively analyzed.Sixty-four subjects were enrolled in the Viabahn group and 37 were enrolled in the Fluency group.The geometry characteristics of the TIPS were calculated,and the associated occurrence of shunt dysfunction,survival,overt hepatic encephalopathy,and variceal rebleeding were evaluated.Results:The technical success rate was 100%.After the insertion of the TIPS,the rate of shunt dysfunction during the first 3 months was significantly different between the Viabahn and Fluency groups(1.6% and 13.5%,respectively;p=0.024).Multivariate analysis indicated that the angle of portal venous inflow(α) was the only independent risk factor for shunt dysfunction(hazard ratio=1.060,95% confidence interval=1.009-1.112,p=0.020).In addition,3 months after the TIPS insertion,the a angle distinctly increased from 20.9°±14.3°-26.9°±20.1°(p=0.005) in the Fluency group but did not change significantly in the Viabahn group(from 21.9°±15.1°-22.9°± 17.6°,p=0.798).Conclusions:Shunt dysfunction was related to the a angle owing to the slight effect on the a angle after the implantation of the TIPS.The Viabahn ePTFE covered stent/BMS combination was more stable in structure and promised higher short-term stent patency compared with the Fluency ePTFE covered stent/BMS combination.

关键词： Transjugular intrahepatic portosystemic shunt Stents Portal venous inflow Shunt dysfunction Hepatic encephalopathy

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肝硬化患者经颈静脉肝内门体分流术与肝硬化肌少症的关系

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临床肝胆病杂志 2023年第7期39卷 1541-1546页

作者：熊斌杨崇图广州医科大学附属第一医院介入科广州511407 四川大学华西医院放射科成都610041

肌肉减少症(肌少症)是肝硬化的常见并发症,与不良预后显著相关。经颈静脉肝内门体分流术(TIPS)是治疗肝硬化门静脉高压相关并发症的重要手段。基于现有研究证据,分析了肌少症与TIPS术后肝硬化患者各结局事件(肝性脑病、死亡)发生的关联... 详细信息

肌肉减少症(肌少症)是肝硬化的常见并发症,与不良预后显著相关。经颈静脉肝内门体分流术(TIPS)是治疗肝硬化门静脉高压相关并发症的重要手段。基于现有研究证据,分析了肌少症与TIPS术后肝硬化患者各结局事件(肝性脑病、死亡)发生的关联,以及肌少症对于现有预后模型预测能力的改善价值;此外,分析了TIPS术后肌少症的改善及其对于肝硬化患者临床管理的意义。从现有报道综合分析发现:基线肌少症与TIPS术后不良预后有关,建议在TIPS术前基于影像学检查常规评估患者营养状况;TIPS术可改善部分患者的营养状况,使得肌少症逆转或改善达到一定程度并可转化为生存获益,故对于部分存在肌少症且病情稳定的肝硬化患者,经综合评估后可尽早行TIPS治疗。

关键词：肝硬化门静脉高压门体分流术经颈静脉肝内肌减少症

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支架亚扩张对经颈静脉肝内门体分流术后肝性脑病发生率的影响分析

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中华内科杂志 2022年第5期61卷 537-542页

作者：王朝阳熊斌刘家成杨崇图琚书光白耀威姚伟王迎亮华中科技大学同济医学院附属协和医院放射科武汉430000

目的:探讨支架亚扩张能否降低经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)后肝性脑病发生率。方法:回顾性分析2017年3月至2020年9月于华中科技大学同济医学院附属协和医院介入科行TIPS治疗的197例肝... 详细信息

目的:探讨支架亚扩张能否降低经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)后肝性脑病发生率。方法:回顾性分析2017年3月至2020年9月于华中科技大学同济医学院附属协和医院介入科行TIPS治疗的197例肝硬化失代偿期患者,其中男性110例、女性87例,年龄25~79(54±11)岁。所有患者术中均置入直径8 mm裸支架+覆膜支架,并采用直径6 mm或8 mm球囊扩张。根据球囊直径大小,患者分为亚扩张组(6 mm,105例)与对照组(8 mm,92例)。术后累积肝性脑病发生率采用Kaplan-Meier法进行分析,两组间的比较采用log-rank检验。采用多因素Cox回归分析探讨TIPS术后发生肝性脑病的独立危险因素。结果:两组患者术后中位随访时间为29(12~54)个月,亚扩张组患者16例(15.2%)出现肝性脑病,显著低于对照组27例(29.3%)( P=0.014),但两组患者消化道再出血率、支架功能障碍率及生存率差异无统计学意义( P=0.608, P=0.659, P=0.968)。在多变量Cox回归分析中,分组(亚扩张组比对照组)( HR=0.291,95% CI 0.125~0.674, P=0.004)是TIPS术后肝性脑病发生的独立危险因素。结论:支架亚扩张可降低TIPS术后肝性脑病发生率,且不增加消化道再出血率、支架功能障碍率及死亡风险,可在临床上进一步推广应用。

关键词：亚扩张门体分流术,经颈静脉肝内肝性脑病

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经颈静脉肝内门体分流术后肝性脑病预后因素研究进展

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介入放射学杂志 2022年第3期31卷 301-306页

作者：陈杨刘家成杨崇图石钦王迎亮黄松江李铜强熊斌华中科技大学同济医学院附属协和医院放射科、分子影像湖北省重点实验室武汉430022

1988年经颈静脉肝内门体分流术(TIPS)首次临床应用以来,TIPS相关理论和技术日益完善。然而术后肝性脑病(HE)发生仍是限制其临床广泛应用的主要并发症。因此,掌握TIPS术后HE发生的预后因素,可有效预防其发生。既往已有许多TIPS术后HE预... 详细信息

1988年经颈静脉肝内门体分流术(TIPS)首次临床应用以来,TIPS相关理论和技术日益完善。然而术后肝性脑病(HE)发生仍是限制其临床广泛应用的主要并发症。因此,掌握TIPS术后HE发生的预后因素,可有效预防其发生。既往已有许多TIPS术后HE预后因素的报道,包括患者年龄、术前HE发生史、Child-Pugh分级、血氨水平、门静脉压力梯度等。本文主要就TIPS术后HE预后因素最新研究进展及本中心经验作一综述。

关键词：经颈静脉肝内门体分流术肝性脑病预后因素

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提高经颈静脉肝内门体分流术治疗门静脉闭塞技术成功率的辅助靶标手段

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介入放射学杂志 2022年第8期31卷 805-809页

作者：李铜强刘家成周晨石钦王迎亮黄松江杨崇图陈杨熊斌华中科技大学同济医学院附属协和医院放射科、分子影像湖北省重点实验室武汉430022

目的探讨提高经颈静脉肝内门体分流术(TIPS)治疗门静脉闭塞(PVO)技术成功率的辅助靶标手段及其安全性和有效性。方法纳入22例应用辅助靶标手段行TIPS治疗的PVO患者。其中11例应用经皮经肝门静脉靶标(PTPVT)技术,10例应用肝动脉导丝靶... 详细信息

目的探讨提高经颈静脉肝内门体分流术(TIPS)治疗门静脉闭塞(PVO)技术成功率的辅助靶标手段及其安全性和有效性。方法纳入22例应用辅助靶标手段行TIPS治疗的PVO患者。其中11例应用经皮经肝门静脉靶标(PTPVT)技术,10例应用肝动脉导丝靶标(HAT)技术,1例两种辅助手段联合应用。结果 1例失败,技术成功率为95.5%(21/22)。成功建立分流道患者门静脉压力梯度(PPG)由(28.4±7.7) mmHg(1 mmHg=0.133 kPa)降至(12.1±4.5) mmHg(P<0.01)。术中未出现危及生命的严重并发症。中位随访时间14.9个月,术后累积支架通畅率为81.8%(18/22);6例发生静脉曲张再出血,累积再出血率为27.3%;3例出现肝性脑病;1例因发生感染死亡。结论 TIPS是治疗PVO的安全有效方法,辅助靶标手段可提高TIPS的技术成功率。

关键词：经颈静脉肝内门体分流术门静脉闭塞辅助靶标手段

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血小板减少症患者经颈静脉肝内门体分流术安全性和预后分析

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介入放射学杂志 2022年第8期31卷 765-769页

作者：白耀威刘家成熊斌杨崇图王迎亮周晨黄松江李铜强陈杨华中科技大学同济医学院附属协和医院放射科、分子影像湖北省重点实验室武汉430022

目的探讨肝硬化门静脉高压伴血小板减少症患者接受经颈静脉肝内门体分流术(TIPS治疗的安全性和预后。方法回顾性选取2015年11月至2021年5月在武汉协和医院接受TIPS术治疗的229例门静脉高压患者,根据术前患者血小板计数(PLT)分为重度血... 详细信息

目的探讨肝硬化门静脉高压伴血小板减少症患者接受经颈静脉肝内门体分流术(TIPS治疗的安全性和预后。方法回顾性选取2015年11月至2021年5月在武汉协和医院接受TIPS术治疗的229例门静脉高压患者,根据术前患者血小板计数(PLT)分为重度血小板减少组(PLT20×10^(9)/L)患者行TIPS术是安全的,血小板减少症严重程度与经TIPS治疗肝硬化门静脉高压患者预后无关。

关键词：肝硬化门静脉高压症经颈静脉肝内门体分流术血小板减少症

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载药栓塞材料在肝癌治疗中的应用

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中华介入放射学电子杂志 2020年第4期8卷 364-369页

作者：石钦周晨刘家成黄松江杨崇图熊斌华中科技大学同济医学院附属协和医院放射科分子影像湖北省重点实验室湖北武汉430022

原发性肝癌是全球最常见的恶性肿瘤之一,其发病率和死亡率均居前列。肝动脉化疗栓塞(transarterial chemoembolization,TACE)是中晚期肝癌的首选治疗手段,通过将栓塞剂和化疗药物混合靶向递送至肿瘤区域,实现局部缺血坏死的同时减少药... 详细信息

原发性肝癌是全球最常见的恶性肿瘤之一,其发病率和死亡率均居前列。肝动脉化疗栓塞(transarterial chemoembolization,TACE)是中晚期肝癌的首选治疗手段,通过将栓塞剂和化疗药物混合靶向递送至肿瘤区域,实现局部缺血坏死的同时减少药物全身副作用。其中,栓塞材料在TACE抗肝癌的功效中起着至关重要的作用。目前,已有多种栓塞材料通过不同的载药机制与化疗药物结合,并应用于肝癌治疗。本文就目前研发的载药栓塞材料在肝癌中的应用作一综述。

关键词：原发性肝癌肝动脉化疗栓塞栓塞材料载药机制

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