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经颈静脉肝内门体分流术对心肺的影响:肺动脉压增高的作用

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世界核心医学期刊文摘（胃肠病学分册） 2005年第1期1卷 47-48页

作者： Schwartz J.M. Beymer C. Althaus S.J. 程欣 Oregon Health Sciences U niversity Division of Gastroenterology 3181 SW Sam Jackson Park RoadPortland OR 97239 United States

Goals: To determine whether increased pulmonary artery pressure(PAP) following transjugular intrahepatic portosystemic shunting (TIPSS) results in short-term mortality or cardiorespiratory complications. Background: TIPSS is frequently performed for complications of cirrhosis. PAP increases following TIPSS; however consequences of this phenomenon are unknown. Study: Demographics, disease severity and etiology were recorded among patients undergoing TIPSS. PAP before and following TIPSS were measured and the relationship between PAP before and after TIPSS, and subsequent cardiorespiratory complications and mortality was examined. Results:Thirty-one patients were enrolled (mean age 53 years,74% men,55% Child-Pugh class C cirrhosis). TIPSS was performed for variceal bleeding in 84% of cases. Ten patients (32% ) died 5-20 days following TIPSS. PAP increased significantly following TIPSS (mean 20.8 mm Hg pre-TIPSS (95% CI 18.2-23.4) to 26.9 mm Hg post-TIPSS(95% CI 24.2-29.6, P=0.0016). Congestive heart failure developed in 4 patients (13% ), sepsis in 4 (13% ), and ARDS in 8 (26% ). Increased PAP following TIPSS was not associated with early mortality (P=0.13), CHF(P=0.31), or ARDS (P=0.43). ARDS was the only significant predictor of short-term mortality following TIPSS (OR 18.7,P=0.02 (95% CI 1.5-232)). Conclusion: PAP increases after TIPSS and cardiorespiratory complications are common, yet unrelated to increased PAP. ARDS is independently associated with increased risk of mortality after TIPSS.

关键词：肺动脉压经颈静脉肝内门分流术肝硬化程度静脉曲张破裂心肺并发症早期死亡率慢性心力衰竭充血性心力衰竭疾病严重程度

经颈静脉肝内门——腔静脉内支架分流术治疗肝硬化门脉高压症5例报告

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大连大学学报 1994年第3期15卷 363-364页

作者：杨秋吉高众周庆涛于光孟兆清姜殿威封守新大连市中心医放射科

经颈静脉肝内门——腔静脉内支架分流术是近几年介入放射学的又一新课题。此技术难度大费用昂贵。目前国内正在逐步开展,我院自94年引进此技术并应用于临床,共完成5例,除一例未成功外其余4例均获得了满意的效果,其中3例术后2周重返工作... 详细信息

经颈静脉肝内门——腔静脉内支架分流术是近几年介入放射学的又一新课题。此技术难度大费用昂贵。目前国内正在逐步开展,我院自94年引进此技术并应用于临床,共完成5例,除一例未成功外其余4例均获得了满意的效果,其中3例术后2周重返工作岗位。现报告如下。1

关键词：经颈静脉肝内门分流术内支架腔静脉食道静脉曲张胃底静脉工作岗位肝内分流介入放射学分流道

经颈静脉肝内门腔分流术治疗食管胃曲张的解剖学基础和护理

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解剖学研究 2015年第4期37卷 288-289页

作者：赵丽解放军153中心医院护理部河南郑州450042

食管胃底静脉破裂出血是门静脉高压引起的一种常见的严重并发症,若出血量大可致出血性休克和诱发肝性脑病,病死率高达40%～50%。经颈静脉肝内门体静脉分流术（TIPSS）是治疗门静脉高压症的新技术,它是通过介入放射学的方法,在肝内建立... 详细信息

食管胃底静脉破裂出血是门静脉高压引起的一种常见的严重并发症,若出血量大可致出血性休克和诱发肝性脑病,病死率高达40%～50%。经颈静脉肝内门体静脉分流术（TIPSS）是治疗门静脉高压症的新技术,它是通过介入放射学的方法,在肝内建立一条连接门-肝静脉的限制性分流通道，使部分门脉血流直接进入体循环，从而达到降低门脉压力，防止食管及胃底静脉曲张破裂出血的目的。以其创伤性小，适应证广，成功率高，逐渐在临床上得以应用。我院在2011年3月至2014年3月为12例食管静脉破裂出血患者施行了TIPSS，并进行了有针对性的护理措施，均圆满完成TIPSS，效果良好。现报道如下。

关键词：食管胃底静脉解剖学基础门静脉高压症分流术出血性休克肝性脑病经颈静脉肝内门介入放射学肝静脉静脉栓塞术

我国经颈静脉肝内门体分流技术的发展现状及其规范化

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中华介入放射学电子杂志 2013年第2期1卷 1-6页

作者：褚建国解放军空军总医院放射科北京100142

迄今,世界范围内尚无某项介入诊疗技术在推广和普及方面进展得如此之慢,能够开展的医院如此之少。但却有大量的患者来源,这就是经颈静脉肝内门体分流术（transjugular intrahepatic portosystemic shunt,TIPS）。究其原因,就是TIPS具有... 详细信息

迄今,世界范围内尚无某项介入诊疗技术在推广和普及方面进展得如此之慢,能够开展的医院如此之少。但却有大量的患者来源,这就是经颈静脉肝内门体分流术（transjugular intrahepatic portosystemic shunt,TIPS）。究其原因,就是TIPS具有相当高的技术难度和难以补救的术中并发症。笔者经过21年5 680例TIPS的临床应用研究发现,TIPS的影像学分析确定术中的术式选择,

关键词：经颈静脉肝内门 TIPS 支架术门静脉高压介入诊疗技术金属血管内支架分流道间接门静脉造影镍钛合金术中并发症

与经颈静脉肝内门体分流术相关的复发性肠球菌菌血症(法)

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世界核心医学期刊文摘（胃肠病学分册） 2005年第7期1卷 21-22页

作者： Passeron A. Mihla- Amrouche L. Perreira Rocha E. 翟惠虹 Departement de Medecine Interne Hopital Europeen Georges Pompidou 75015 Paris France

Transjugular intrahepatic portosystemic shunts (TIPS) are an accepted techniq ue for controlling the complications of portal hypertension. Although the incide nce of TIPS- associated bacteremia appears to be low (2% ), this complication has a high mortality. We report one case of recurrent enterococcal bacteremia as sociated with TIPS and regression of TIPS thrombus after antibiotherapy. The ant ibiotic regimen is similar to that given in bacterial endocardites.

关键词：肠球菌菌血症经颈静脉肝内门分流术 TIPS 门脉高压细菌性心内膜炎

远侧脾-肾分流术与经颈静脉肝内门体分流术治疗静脉曲张破裂出血:一项随机研究

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世界核心医学期刊文摘（胃肠病学分册） 2006年第10期2卷 29-30页

作者： Henderson J.M. Boyer T.D. Kutner M.H. 纪泛扑 Department of Surgery Cleveland ClinicClevelandOHUnited States

Background &Aims: Variceal bleeding refractory to medical treatment with β-blockers and endoscopic therapy can be managed by variceal decompression with either surgical shunts or transjugular intrahepatic portal systemic shunts (TIPS). This prospective randomized trial tested the hypothesis that patients receiving distal splenorenal shunts (DSRS) would have significantly lower rebleeding and encephalopathy rates than TIPS in management of refractory variceal bleeding. Methods: A prospective randomized controlled clinical trial at 5 centers was conducted. One hundred forty patients with Child-Pugh class A and B cirrhosis and refractory variceal bleeding were randomized to DSRS or TIPS. Protocol and event follow-up for 2-8 years (mean, 46 ±26 months) for primary end points of variceal bleeding and encephalopathy and secondary end points of death, ascites, thrombosis and stenosis, liver function, need for transplant, quality of life, and cost were evaluated. Results: There was no significant difference in rebleeding (DSRS, 5.5%; TIPS, 10.5%; P = .29) or first encephalopathy event (DSRS, 50%; TIPS, 50%). Survival at 2 and 5 years (DSRS, 81%and 62%; TIPS, 88%and 61%, respectively) were not significantly different (P = .87). Thrombosis, stenosis, and reintervention rates (DSRS, 11%; TIPS, 82%) were significantly (P < .001) higher in the TIPS group. Ascites, need for transplant, quality of life, and costs were not significantly different. Conclusions: DSRS and TIPS are similarly efficacious in the control of refractory variceal bleeding in Child-Pugh class A and B patients. Reintervention is significantly greater for TIPS compared with DSRS. Because both procedures have equivalent outcomes, the choice is dependent on available expertise and ability to monitor the shunt and reintervene when needed.

关键词：静脉曲张破裂分流术经颈静脉肝内门 TIPS 随机研究肝移植 β-阻滞剂肝性脑病次要终点血

顽固性腹水患者的生活质量评估:经颈静脉肝内门体分流术与内科对比治疗

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世界核心医学期刊文摘（胃肠病学分册） 2006年第1期2卷 40-41页

作者： Campbell M .S. Brensinger C.M. Sanyal A.J. K.R. Reddy 李翔 Division of Gastroenterology 3 Ravdin Hospital of the University of Pennsylvania 3400 Spruce Street Philadelphia PA19104United States Dr.

Uncontrolled studies suggest that transjugular intrahepatic portal-systemic shunting (TIPS) may improve quality of life in patients with refractory ascites. We hypothesized that any improvement of quality of life in patients with TIPS would be matched in controls due to the competing effects of improved ascites and worsened hepatic encephalopathy. Thus, an analysis of quality of life was performed using original data from the North American Study for the Treatment of Refractory Ascites, a multicenter trial of 109 patients randomized to TIPS or repeated large volume paracentesis (LVP) for refractory ascites. Short form 36 (SF-36) surveys were completed at baseline and at 6-and 12-month follow-up. Variables analyzed were: randomization group, number of LVP performed, cumulative volume from LVP, shortness of breath, abdominal distention, abdominal pain, diuretic usage, confusion, hospitalizations, and emergency room visits. Outcomes were changes in physical component scale (PCS) and mental component scale (MCS) of SF-36 results. We constructed multivariable, mixed effects models, including randomization group and baseline MCS and PCS. Changes in PCS and MCS from baseline were similar between the two randomization groups. In multivariate analysis, PCS improvement was associated with lack of confusion, improved ascites, and lack of hospitalizations, but not directly with randomization group. Improvement in MCS was associated with randomization to TIPS and lack of confusion. In conclusion, patients with refractory ascites randomized to TIPS or repeated LVP had similar changes in quality of life. Competing effects of hepatic encephalopathy, requirement for repeated LVP, and need for hospitalizations explain similar changes in quality of life between the two groups.

关键词：顽固性腹水经颈静脉肝内门生活质量评估分流术 TIPS 对比治疗随机化肝性脑病急诊治疗呼

出血性异位血管曲张:经颈静脉肝内门体分流术(TIPS)及栓塞术治疗

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世界核心医学期刊文摘（胃肠病学分册） 2005年第3期1卷 56-57页

作者： Vangeli M. Patch D. Terreni N. 姜志茹

Bleeding ectopic varices due to cirrhosis can be difficult to manage. We report our experience of uncontrolled bleeding from ectopic varices treated with transjugular intrahepatic porto systemic shunt (TIPS).We selected the 21 cirrhotics who underwent TIPS for bleeding ectopic varices from our database: Child Pugh grade A(2), B (11) and C(8). Site of bleeding was rectal(11), colonic (2), ileal(1), jejunal(1), duodenal(1), and stomal(5). TIPS was performed successfully in 19/21(90%) patients. All except 1 had either a reduction in portosystemic pressure gradient ≤12 mmHg(n=12) or reduction by 25-50%of baseline(n=6). TIPS alone was used in 12/19: 7 of these 12 had no further bleeding; 5 (42%) rebled within 48 h, and had embolisation, 4 without further bleeding. In 7 of 19, TIPS and embolisation were performed together: 2 patients(28%) rebled; further embolisation stopped the bleeding. Ectopic varices do rebleed despite a reduction of porto systemic pressure gradient ≤12 mmHg or by 25-50%of baseline, following TIPS. Embolisation stopped bleeding in all but 1 patient. We recommend performing embolisation at the time of the initial TIPS to control bleeding from ectopic varices.

关键词： TIPS 经颈静脉肝内门分流术栓塞术治疗再出血门体基线水平压力梯度循环压力张行

经颈静脉肝内门体分流术治疗慢性原发性布加综合征的长期结局和分流道功能障碍情况

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临床肝胆病杂志 2017年第3期33卷 471-471页

作者：张鑫彤祁兴顺郭晓钟沈阳军区总医院消化内科

【据《Radiology》2016年10月报道】题：经颈静脉肝内门体分流术治疗慢性原发性布加综合征的长期结局和分流道功能障碍情况（作者Hayek G等）评估经颈静脉肝内门体分流术（TIPS）治疗布加综合征的长期安全性、技术成功率和有效性,鉴定T... 详细信息

【据《Radiology》2016年10月报道】题：经颈静脉肝内门体分流术治疗慢性原发性布加综合征的长期结局和分流道功能障碍情况（作者Hayek G等）评估经颈静脉肝内门体分流术（TIPS）治疗布加综合征的长期安全性、技术成功率和有效性,鉴定TIPS术后分流道功能障碍的危险因素。该研究纳入2004年-2013年所有行TIPS治疗的原发性布加综合征患者。

关键词：布加综合征分流术经颈静脉肝内门分流道 TIPS 技术成功率功能障碍长期安全性顽固性腹水通畅率