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世界胃肠外科杂志:英文版(电子版) 2023年第8期15卷 1564-1573页

作者： Lan-Jing Wang Xin Yao Qi Qi Jian-Ping Qin Department of Gastroenterology The General Hospital of Western Theater CommandChengdu 610083Sichuan ProvinceChina

transjugular intrahepatic portosystemic shunt(TIPS)is an established procedure for treating the complications of portal hypertension in liver cirrhosis.While the pathogenesis of postoperative TIPS-related hepatic encephalopathy(HE)has yet to be fully understood,intraoperative portosystemic shunts may provide a pathological basis for the occurrence of postope-rative HE in patients with liver cirrhosis.Studies at home and abroad have expressed mixed opinions about TIPSrelated HE.This study presents a literature review on the risk factors for and prevention and treatment of perioperative TIPS-related HE in patients with liver cirrhosis,aiming to optimize the procedure and reduce the incidence of postoperative HE.

关键词： Portosystemic shunt transjugular intrahepatic Hepatic encephalopathy Liver cirrhosis Hypertension Portal Therapeutics

Comparison of survival prediction values of different scoring models for patients undergoing transjugular intrahepatic portal shunt:A multicenter retrospective study

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Portal Hypertension & Cirrhosis 2022年第2期1卷 107-115页

作者： Yuyi Liu Zhiyong Mu Wei Xiong Hong Hu Aimin Liu Xuan An Yuqiang Xu Haohong Yu Jinneng Wang Jun Wang Xiao Xiao Dongfeng Chen Liangzhi Wen Department of Gastroenterology Daping HospitalArmy Medical UniversityChongqingChina Department of Gastroenterology The Third Affiliated Hospital of Chongqing Medical UniversityChongqingChina Department of Interventional Radiology Nanchong Central HospitalThe Second Clinical Medical CollegeThe North Sichuan Medical College(University)NanchongSichuanChina Department of Gastroenterology Fuling Central Hospital Affiliated to Chongqing UniversityChongqingChina Department of Hepatology Chongqing University Three Gorges HospitalChongqingChina Department of Gastroenterology Leshan People's Hospital of SichuanLeshanSichuanChina Department of Gastroenterology Qianjiang Central Hospital of ChongqingChongqingChina Department of Gastroenterology The Ninth People's Hospital of ChongqingChongqingChina

Aim:The aim of this study is to compare the prognostic values of the Child–Pugh,integrated model for end‐stage liver disease(iMELD),albumin–bilirubin(ALBI),and Freiburg index of postsurvival(FIPS)scores in patients undergoing transjugular intrahepatic portosystemic shunt(TIPS).Methods:We conducted a multicenter retrospective study including patients who underwent TIPS by collecting data from several hospitals in southwest China between January 2014 and February 2021.We compared the performance of different scoring models for survival prediction in these patients.The performance of each scoring model was assessed via area under the receiver‐operating characteristic(AUROC)curve analysis.Results:The study included 378 TIPS patients(268 men,110 women;median age 52[interquartile range,45–60]years).Age;cirrhosis etiology;ascites severity;albumin levels;international normalized ratio;total bilirubin levels;sodium levels;and Child–Pugh,iMELD,ALBI,and FIPS scores were significant prognostic factors in cirrhotic patients who underwent TIPS.The Child–Pugh,iMELD,ALBI,and FIPS scores were all independent predictors of survival in TIPS patients.Survival analysis showed that all scoring models effectively stratified the prognostic risk of these patients.The Child–Pugh score was the best predictor of postoperative survival,followed by the ALBI and FIPS scores.The iMELD score was the worst predictor.The Child–Pugh,iMELD,ALBI,and FIPS scores predicted the 1‐year postoperative survival,with AUROC values of 0.832,0.677,0.761,and 0.745,respectively,and the 3‐year postoperative survival,with AUROC values of 0.710,0.668,0.721,and 0.658,respectively.The calibration curve showed that the Child–Pugh,ALBI,and FIPS models performed well in predicting 1‐and 3‐year survival,whereas the iMELD model was a poor predictor.Conclusions:The four scoring models can predict survival in cirrhotic patients after TIPS and can effectively stratify prognostic risk.The Child–Pugh score may be more suitable for predicting survival after TIPS in patients with

关键词： albumin bilirubin end‐stage liver disease liver cirrhosis portosystemic shunt transjugular intrahepatic

Computed tomography-based score model/nomogram for predicting technical and midterm outcomes in transjugular intrahepatic portosystemic shunt treatment for symptomatic portal cavernoma

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World Journal of Clinical Cases 2020年第5期8卷 887-899页

作者： Xiang-Ke Niu Sushant Kumar Das Hong-Lin Wu Yong Chen Department of Radiology Affiliated Hospital of Chengdu UniversityChengdu 610081Sichuan ProvinceChina Department of Radiology Affiliated Hospital of North Sichuan Medical CollegeNanchong 637000Sichuan ProvinceChina Department of Interventional Radiology Nanfang HospitalSouthern Medical UniversityGuangzhou 510515Guangdong ProvinceChina

BACKGROUND transjugular intrahepatic portosystemic shunt(TIPS)may be technically difficult in patients with cavernous transformation of the portal vein(CTPV).Computed tomography(CT)is widely used for assessing the situation of the portal vein and its tributaries before TIPS,and an ultrasound-based Yerdel grading system has been developed,which is deemed useful for liver transplantation.Therefore,we hypothesized that a CT-based CTPV scoring system could be useful for predicting technical and midterm outcomes in TIPS treatment for symptomatic portal cavernoma.AIM To investigate the clinical significance of a CT-based score model/nomogram for predicting technical success and midterm outcome in TIPS treatment for symptomatic CTPV.METHODS Patients with symptomatic CTPV who had undergone TIPS from January 2010 to June 2017 were retrospectively analysed.The CTPV was graded with a score of 1-4 based on contrast-CT imaging findings of the diseased vessel.Outcome measures were technical success rate,stent patency rate,and midterm survival.Cohen’s kappa statistic,the Kaplan-Meier and log-rank tests,and uni-and multivariable analyses were performed.A nomogram was constructed and verified by calibration and decision curve analysis.RESULTS A total of 76 patients(45 men and 31 women;mean age,52.3±14.7 years)were enrolled in the study.The inter-reader agreement(κ)of the CTPV score was 0.81.TIPS was successfully placed in 78%of patients(59/76).The independent predictor of technical success was CTPV score(odds ratio[OR]=5.56,95%confidence interval[CI]:3.55-9.67,P=0.002).The independent predictors of primary TIPS patency were CTPV score and splenectomy(OR=9.22,95%CI:4.78-13.45,P=0.009;OR=4.67,95%CI:2.59-7.44,P=0.017).The survival rates differed significantly between the TIPS success and failure groups.The clinical nomogram was made up of patient age,model for end-stage liver disease score,and CTPV score.The calibration curves and decision curve analysis verified the usefulness of the CTPV score-based nomogram for clinical practice.

关键词： Portosystemic shunt transjugular intrahepatic Liver cirrhosis Portal hypertension Oesophageal and gastric varices Bleeding Shunt dysfunction

Effect of VIATORR stent in early ultrasound evaluation after transjugular intrahepatic portosystemic shunt(TIPS): A case report

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Journal of Interventional Medicine 2020年第2期3卷 106-108页

作者： Heng Du Yong Yao Suyu He Lei Feng Hang Wu Department of Gastroenterology Suining Central HospitalSuining629000China Department of Ultrasonography Suining Central HospitalSuining629000China

Shunt dysfunction is a major complication of transjugular intrahepatic portosystemic shunt(TIPS). Ultrasonography is a preferred method of shunt follow-up after TIPS, but some misjudgments can occur in cases of shunt dysfunction due to peculiarities of the VIATORR stent. Here we report one case and suggest that the first ultrasound evaluation for patients who received TIPS procedure with VIATORR stent should be performed one month after the procedure.

关键词： Ultrasonography Doppler Color Portosystemic shunt transjugular intrahepatic VIATORR stent Case report

Influence of different portal vein branches on hepatic encephalopathy during intrahepatic portal shunt via jugular vein

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World Journal of Gastroenterology 2022年第31期28卷 4467-4470页

作者： Xin Yao Sheng He Meng Wei Jian-Ping Qin Department of Gastroenterology General Hospital of Western Theater CommandChengdu 610083Sichuan ProvinceChina

This letter is regarding the study titled‘Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt(TIPS)to reduce hepatic encephalopathy’.Prior to the approval of TIPS dedicated stents(Viatorr stents)in China in October 2015,Fluency covered stents were typically used.As Fluency covered stents have a strong support force and axial elastic tension,a‘cap’may form if the stent is located too low at the end of the hepatic vein or too short at the end of the portal vein during surgery,leading to stent dysfunction.Since the blood shunted by the stent is from the main trunk of the portal vein,the correlation between the incidence of postoperative hepatic encephalopathy and the location of the puncture target(left or right portal vein branch)is worth discussion.Notably,no studies in China or foreign countries have proven the occurrence of left and right blood stratification after the accumulation of splenic vein and mesenteric blood flow in the main trunk of the portal vein in patients with cirrhotic portal hypertension.

关键词： Viatorr stent Portosystemic shunt transjugular intrahepatic Hypertension portal Left and right portal vein branches