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tips在慢加急性肝衰竭静脉曲张再出血高风险人群中的应用和评价

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肝脏 2024年第5期29卷 596-599页

作者：陈治莉谢青莫瑞东上海交通大学医学院附属瑞金医院感染科 200025 成都市公共卫生临床医疗中心肝病一科四川610066

静脉曲张出血是肝硬化门静脉高压的一个严重并发症。在慢加急性肝衰竭(ACLF)的情况下,静脉曲张再出血发生率和短期病死率均很高。治疗和(或)消除诱因(主要为细菌感染和酒精性肝炎)及降低门静脉压力可改善急性失代偿及ACLF患者的预后。... 详细信息

静脉曲张出血是肝硬化门静脉高压的一个严重并发症。在慢加急性肝衰竭(ACLF)的情况下,静脉曲张再出血发生率和短期病死率均很高。治疗和(或)消除诱因(主要为细菌感染和酒精性肝炎)及降低门静脉压力可改善急性失代偿及ACLF患者的预后。早期开展经颈静脉肝内门体分流(tips)可有效控制出血,防止再出血和降低短期病死率。因此,tips可作为ACLF伴静脉曲张出血患者的一种治疗选择。

关键词： tips 慢加急性肝衰竭静脉曲张出血急性失代偿

不同病因肝硬化患者经颈静脉肝内门体分流术临床疗效

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临床医学进展 2024年第3期14卷 1006-1012页

作者：陈星均阿迪莱·麦麦提伊敏张永萍新疆医科大学研究生院新疆乌鲁木齐新疆维吾尔自治区人民医院感染性疾病科新疆乌鲁木齐

目的:探讨不同病因引起的肝硬化患者经颈静脉肝内门体分流术(Transjugular Intrahepatic Portasystemic Shunt, tips)治疗的预后差异的临床意义。方法:回顾性分析2016年10月~2021年10月我院的肝硬化患者的临床资料,根据肝硬化病因分为... 详细信息

目的:探讨不同病因引起的肝硬化患者经颈静脉肝内门体分流术(Transjugular Intrahepatic Portasystemic Shunt, tips)治疗的预后差异的临床意义。方法:回顾性分析2016年10月~2021年10月我院的肝硬化患者的临床资料,根据肝硬化病因分为病毒性肝炎组与非病毒性肝炎组。比较两组患者性别、年龄、合并症、手术病因、术后6个月生存情况差异,比较分析两组患者肝功能储备变化及预后,比较tips术前术后指标变化。组间计量资料用t检验,非正态分布采用秩和检验,术前术后比较采用配对t检验,计数资料卡方检验进行比较。结果:两组患者年龄、手术病因、合并症(冠心病、糖尿病、感染、肝性脑病)方面、术后6个月生存率、肝功能分级(Child、MELD评分、FIPS评分)比较差异无统计学意义(P > 0.05),性别构成、合并肝癌差异有统计学意义(P 0.05),在术前术后血小板(platelets, PLT)、术后谷丙转氨酶(glutamate pyruvate transaminase, ALT)方面比较差异有统计学意义(P tips治疗后更容易发生短期内肝功能改变。

关键词：病毒性肝炎肝硬化 tips 病因

Can a laparoscopic surgery be an alternative to transjugular intrahepatic portosystemic shunts (tips) for the treatment of portal hypertensive bleeding?

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Hepatobiliary Surgery and Nutrition 2023年第1期12卷 151-154页

作者： Bin Huang Tianfu Wen Liver Transplantation Center Department of Liver SurgeryWest China Hospital of Sichuan UniversityChengduChina

We read with great confusion the guidance written by Garcia-Tsao et al.(1).In the practice guidance developed by the American Association for the Study of Liver Diseases(AASLD),there is no trail of surgical operation for the treatment of portal hypertensive bleeding in cirrhosis at all.However,it is well known that surgical shunts played an important role in this setting before the emergence of transjugular intrahepatic portosystemic shunts(tips),existing studies have shown that surgical shunt still has better long-term patency and survival than tips(2),and surgical portoazygous devascularization is still considered as the most direct and effective way of hemostasis in some countries(3).

关键词： tips hypertensive shunt

Status of transjugular intrahepatic portosystemic shunt for portal hypertension in China:A national survey analysis

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Portal Hypertension & Cirrhosis 2023年第1期2卷 9-15页

作者： Haibo Shao Xinwei Han Jianbo Zhao Junhui Sun Zhuting Fang Bin Xiong Xiaoli Zhu Weixin Ren Min Yuan Shiping Yu Meng Niu Weifu Lv Xueqiang Zhang Chunqing Zhang Lei Li Xuefeng Luo Yusheng Song Yilong Ma Tong Dang Hua Xiang Yun Jin Hui Xue Guiyun Jin Xiao Li Jiarui Li Shi Zhou Changlu Yu Song He Lei Yu Hongmei Zu Jun Ma Yanming Lei Ke Xu Xiaolong Qi Department of Interventional Therapy The First Hospital of China Medical UniversityShenyangLiaoningChina Department of Interventional Therapy The First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina Department of Interventional Therapy Nanfang HospitalSouthern Medical University/The First School of Clinical MedicineSouthern Medical UniversityGuangzhouGuangdongChina Hepatobiliary and Pancreatic Intervention Center The First Affiliated HospitalCollege of Medicine Zhejiang UniversityHangzhouZhejiangChina Department of Interventional Therapy Fujian Provincial HospitalFuzhouFujianChina Department of Interventional Therapy Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina Department of Interventional Therapy The First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongChina Department of Interventional Therapy The First Affiliated Hospital of Suzhou UniversitySuzhouJiangsuChina Department of Interventional Therapy The First Affiliated Hospital of Xinjiang Medical UniversityWulumuqiXinjiangChina Department of Interventional Therapy Shanghai Public Health Clinical Centre Affiliated to Fudan UniversityShanghaiChina Department of Interventional Therapy Second Hospital of Shanxi Medical UniversityTaiyuanShanxiChina Department of Interventional Therapy The First Affiliated Hospital of USTCHefeiAnhuiChina Department of Gastroenterology Second Hospital of HeBei Medical UniversityShijiazhuangHebeiChina Department of Gastroenterology Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina Department of Interventional Therapy The First Hospital of Lanzhou UniversityLanzhouGansuChina Department of Digestion West China Hospital of Sichuan UniversityChengduSichuanChina Department of Interventional Therapy Ganzhou People's HospitalGanzhouJiangxiChina Department of Interventional Therapy Guangxi Medical University Affiliated Tumor Hospital Oncology Medical Colleg

Aim:The transjugular intrahepatic portosystemic shunt(tips)procedure has been performed in China for 30 years,but our understanding of the status and difficulties associated with the use of tips for portal hypertension is incomplete.This study aims to investigate the current situation of the use of tips for portal hypertension,which should aid the development of tips in China.Methods:This study involved a questionnaire survey,initiated by the China Portal Hypertension Alliance(CHESS)to investigate the use of tips for portal hypertension in China.Questionnaires were released on the Internet between August 16,2022 and September 16,2022.Detailed information was collected from 545 hospitals contracted by the CHESS in China,which performed tips surgery in 2021.Results:The 545 hospitals covers the majority of hospitals in China that conduct tips intervention.In the survey,a total of 13,527 tips interventions were carried out with 94.1%(498/545)of them had a system of routine follow‐up after tips.The majority(42.6%[232/545])believed that the main indication of tips was the control of acute bleeding.Overall,48.1%(262/545)carried out early or pre‐emptive tips,53.0%(289/545)carried out tips for cavernous transformation of the portal vein,and 81.0%(441/545)chose routine embolization of collateral circulation during operation.Most used coils(97.0%[475/490])and biological glue(72.0%[353/490])as embolic materials,and 78.5%(428/545)routinely performed intraoperative portal pressure gradient measurements.When selecting tips stents,57.1%(311/545)chose viator‐specific stents,and 57.2%(312/545)chose conventional anticoagulation after tips.Conventional anticoagulation after tips is over a time interval of 3–6 months(55.4%[173/312]).The limitation of tips surgery is mainly its cost(72.3%[394/545])and insufficient understanding of the procedure by doctors in other related departments(77.4%[422/545]).Most of the hospital teams accept the use of domestic instruments in tips surgery(92.7%[505/545]).Conclusions:This survey shows that tips

关键词： application status portal hypertension questionnaire survey tips

The transjugular intrahepatic portosystemic shunt: Smaller stent diameters are required to optimize pressure response

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iLIVER 2023年第2期2卷 89-96页

作者： Martin Rossle Dominik Bettinger Robert Thimme Michael Schultheiss Department of Medicine II Medical Center University of FreiburgFaculty of MedicineUniversity of FreiburgFreiburgGermany Berta-Ottenstein-Programme Faculty of MedicineUniversity of FreiburgGerman

Background and aims:The present treatment goal of the transjugular intrahepatic portosystemic shunt(tips)is a portosystemic pressure gradient of12 mmHg or its reduction by>50%.This study relates the stent diameter to the reduction of the pressure gradient and attempts to predict the appropriate stent diameter necessary to reach the treatment goal.Methods:Pressure response,super response,and poor response were investigated in 208 de-novo tips patients and defined as post-tips gradients between>6 and 12 mmHg,6 mmHg,or not reaching the goal(>12 mmHg,reductiontips gradients(9.71.9 mmHg,4.51.5 mmHg,and 14.21.4 mmHg,ptips gradients(51.711.4%,73.611.1%,and 34.09.1%,p<0.001),and specific reduction per mm of stent diameter(7.52.0%/mm,10.12.0%/mm,and 4.81.4%/mm,p<0.001).Prediction of the stent diameter required to reach response was not possible.Only two super responders had a stent diameter of<6 mm.Super and poor responders differed by the increase in the right atrial pressure(+5.0 mmHg vs.+3.1 mmHg,p=0.026)and reduction in the portal vein pressure(-8.6 mmHg vs.-4.6 mmHg,p<0.001).Conclusion:Most patients reached the treatment goal with stent diameters of<8 mm.Overtreatment(super response,gradient ≤6 mmHg)can be prevented by stent diameters as small as 6 mm.The individual response was not related to the stent diameter and not predictable.Cardiac dysfunction may play an important role by its effect on the right atrial(preload)and portal pressure(afterload).

关键词： Portal hypertension Transjugular intrahepatic portosystemic stentshunt tips Portosystemic pressure gradient Stent diameter Hepatic encephalopathy Cardiac function

肝硬化门静脉高压经颈静脉肝内门体分流术的临床应用

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肝博士 2024年第1期 31-31页

作者：李煜陈世耀上海复旦大学附属中山医院

门静脉高压症是肝硬化患者最常见的临床表现,肝硬化患者在静脉血流因素影响下,常常出现一系列并发症,如威胁生命的上消化道出血、难治性腹水等。经颈静脉肝内门体静脉分流术(tips)是一种微创手术,其原理是通过在肝静脉与门静脉之间的肝... 详细信息

门静脉高压症是肝硬化患者最常见的临床表现,肝硬化患者在静脉血流因素影响下,常常出现一系列并发症,如威胁生命的上消化道出血、难治性腹水等。经颈静脉肝内门体静脉分流术(tips)是一种微创手术,其原理是通过在肝静脉与门静脉之间的肝实质内建立分流道,从结构上显著降低门静脉阻力,目前已广泛应用于肝硬化门静脉高压并发症的治疗。

关键词：肝硬化门静脉高压门静脉高压症静脉血流经颈静脉肝内门体分流术难治性腹水肝实质上消化道出血 tips

Clinical outcome and predictors of survival after tips insertion in patients with liver cirrhosis

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World Journal of Gastroenterology 2012年第37期18卷 5211-5218页

作者： Hauke S Heinzow Philipp Lenz Michael Khler Frank Reinecke Hansjrg Ullerich Wolfram Domschke Dirk Domagk Tobias Meister Department of Medicine B University of Muenster Institute of Radiology University of Muenster Department of Medicine Ⅱ Helios Albert-Schweitzer-Hospital

AIM:To determine the clinical outcome and predictors of survival after transjugular intrahepatic portosystemic stent shunt (tips) implantation in cirrhotic patients. METHODS:Eighty-one patients with liver cirrhosis and consequential portal hypertension had tips implantation (bare metal) for either refractory ascites (RA) (n= 27) or variceal bleeding (VB) (n = 54). Endpoints for the study were:technical success, stent occlusion and stent stenosis, rebleeding, RA and mortality. Clinical records of patients were collected and analysed. Baseline characteristics [e.g., age, sex, CHILD score and the model for end-stage liver disease score (MELD score), underlying disease] were retrieved. The Kaplan-Meier method was employed to calculate survival from the time of tips implantation and comparisons were made by log rank test. A multivariate analysis of factors influencing survival was carried out using the Cox proportional hazards regression model. Results were expressed as medians and ranges. Comparisons between groups were performed by using the Mann-Whitney Utest and the χ 2 test as appropriate. RESULTS:No difference could be seen in terms of age, sex, underlying disease or degree of portal pressure gradient (PPG) reduction between the ascites and the bleeding group. The PPG significantly decreased from 23.4 ± 5.3 mmHg (VB) vs 22.1 ± 5.5 mmHg (RA) before tips to 11.8 ± 4.0 vs 11.7 ± 4.2 after tips implantation (P = 0.001 within each group). There was a tendency towards more patients with stage CHILD A in the bleeding group compared to the ascites group (24 vs 6, P = 0.052). The median survival for the ascites group was 29 mo compared to > 60 mo for the bleeding group (P = 0.009). The number of radiological controls for stent patency was 6.3 for bleeders and 3.8 for ascites patients (P = 0.029). Kaplan-Meier calculation indicated that stent occlusion at first control (P = 0.027), ascites prior to tips implantation (P = 0.009), CHILD stage (P = 0.013), MELD score (P = 0.001) and those patients not having undergone liver

关键词： tips 预测因子临床疗效肝硬化患者 Cox回归模型压力梯度毫米汞柱

Impacts of sodium hydroxide and sodium hypochlorite aging on polyvinylidene fluoride membranes fabricated with different methods

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Journal of Environmental Sciences 2018年第5期30卷 294-308页

作者： Qilong Wu Xihui Zhang Guodong Cao Graduate School at Shenzhen Tsinghua UniversityGuangdong 518055China Foshan Water Group Guangdong 528000China Environmental Science and Technology Laboratory Tsinghua-Berkeley Shenzhen InstituteGuangdong 518055China

This study compared the effects of chemical aging on the polyvinylidene fluoride（PVDF）membranes fabricated with the methods of non-solvent induced phase separation（NIPS）（named NIPS-PVDF） and thermally induced phase separation（tips）（named tips-PVDF）. The chemical solutions of sodium hypochlorite（NaClO） and sodium hydroxide（NaOH） were chosen at the concentration of 5000 mg/L. The equivalence of 5 and 10 years was respectively selected as the time of aging. The physicochemical evolutions of membrane aging are characterized on the base of morphology analysis, chemical components, permeation ability and mechanical properties. The aging of NIPS-PVDF membrane led to the elimination of surface hydrophilic additives, while NaO H focused on the dehydrofluorination process resulting in the formation of conjugated chains of polyene on the skeleton structure. The chemical components of the surface of tips-PVDF membrane were removed continuously during the aging processes of both NaClO and NaOH, which was caused by the saponification of surface additives and the chain scissions of skeleton structure, but without producing any obvious conjugated chains of polyene. All the aging processes led to the increase of contact angle and the decrease of mechanical properties, and the permeability was reduced first and increased later due to the enlargement of surface membrane pores and membrane block. With the influence of membrane aging, selectivity of membrane was decreased（except coliform bacteria）. At the beginning of filtration, the turbidity and particle count were at relatively high levels and declined with the filtration process.

关键词： Micro/ultrafiltration membrane Membrane aging NIPS tips NaOH NaCIO

Treatment of portal hypertension

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World Journal of Gastroenterology 2012年第11期18卷 1166-1175页

作者： Khurram Bari Guadalupe Garcia-Tsao Section of Digestive Diseases Yale University School of MedicineNew HavenCT and VA-Connecticut Healthcare SystemWest HavenCT 06520United States

Portal hypertension is the main complication of cirrhosis and is defined as an hepatic venous pressure gradient(HVPG) of more than 5 mmHg.Clinically significant portal hypertension is defined as HVPG of 10 mmHg or more.Development of gastroesophageal varices and variceal hemorrhage are the most direct consequence of portal hypertension.Over the last decades significant advancements in the field have led to standard treatment options.These clinical recommendations have evolved mostly as a result of randomized controlled trials and consensus conferences among experts where existing evidence has been reviewed and future goals for research and practice guidelines have been proposed.Management of varices/variceal hemorrhage is based on the clinical stage of portal hypertension.No specific treatment has shown to prevent the formation of varices.Prevention of first variceal hemorrhage depends on the size/characteristics of varices.In patients with small varices and high risk of bleeding,nonselective b-blockers are recommended,while patients with medium/large varices can be treated with either b-blockers or esophageal band ligation.Standard of care for acute variceal hemorrhage consists of vasoactive drugs,endoscopic band ligation and antibiotics prophylaxis.Transjugular intrahepatic portosystemic shunt(tips) is reserved for those who fail standard of care or for patients who are likely to fail("early tips").Prevention of recurrent variceal hemorrhage consists of the combination of b-blockers and endoscopic band ligation.

关键词：治疗方案高压受体阻滞剂静脉曲张临床意义毫米汞柱 tips 压力梯度