AIM: To evaluate combination transjugular intrahepatic portosystemic shunt(TIPS) and other interventions for hepatocellular carcinoma(HCC) and portal hypertension.METHODS: Two hundred and sixty-one patients with HCC a...AIM: To evaluate combination transjugular intrahepatic portosystemic shunt(TIPS) and other interventions for hepatocellular carcinoma(HCC) and portal hypertension.METHODS: Two hundred and sixty-one patients with HCC and portal hypertension underwent TIPS combined with other interventional treatments(transarterial chemoembolization/transarterial embolization,radiofrequency ablation,hepatic arterio-portal fistulas embolization,and splenic artery embolization) from January 1997 to January 2010 at Beijing Shijitan Hospital. Two hundred and nine patients(121 male and 88 female,aged 25-69 years,mean 48.3 ± 12.5 years) with complete clinical data were recruited. We evaluated the safety of the procedure(procedurerelated death and serious complications),change of portal vein pressure before and after TIPS,symptom relief [e.g.,ascites,hydrothorax,esophageal gastricfundus variceal bleeding(EGVB)],cumulative rates of survival,and distributary channel restenosis. The characteristics of the patients surviving ≥ 5 and < 5 years were also analyzed.RESULTS: The portosystemic pressure was decreased from 29.0 ± 4.1 mm Hg before TIPS to 18.1 ± 2.9 mm Hg after TIPS(t = 69.32,P < 0.05). Portosystemic pressure was decreased and portal hypertension symptoms were ameliorated. During the 5 year followup,the total recurrence rate of resistant ascites or hydrothorax was 7.2%(15/209); 36.8%(77/209) for EGVB; and 39.2%(82/209) for hepatic encephalopathy. The cumulative rates of distributary channel restenosis at 1,2,3,4,and 5 years were 17.2%(36/209),29.7%(62/209),36.8%(77/209),45.5%(95/209) and 58.4%(122/209),respectively. No procedure-related deaths and serious complications(e.g.,abdominal bleeding,hepatic failure,and distant metastasis) occurred. Moreover,Child-Pugh score,portal vein tumor thrombosis,lesion diameter,hepatic arterio-portal fistulas,HCC diagnosed before or after TIPS,stent type,hepatic encephalopathy,and type of other interventional treatments were related to 5 year survival after comparing patient characteristics.CONCLUSION: TIPS combined with other interventional treatments seems to be safe and efficacious in patients with HCC and portal hypertension.展开更多
AIM:To evaluate the feasibility of transjugular intrahepatic portosystemic shunt(TIPS)for severe jaundice secondary to acute Budd-Chiari syndrome(BCS).METHODS:From February 2009 to March 2013,37patients with severe ja...AIM:To evaluate the feasibility of transjugular intrahepatic portosystemic shunt(TIPS)for severe jaundice secondary to acute Budd-Chiari syndrome(BCS).METHODS:From February 2009 to March 2013,37patients with severe jaundice secondary to acute BCS were treated.Sixteen patients without hepatic venule,hepatic veins(HV)obstruction underwent percutaneous angioplasty of the inferior vena cava(IVC)and/or HVs.Twenty-one patients with HV occlusion underwent TIPS.Serum bilirubin,liver function,demographic data and operative data of the two groups of patients were analyzed.RESULTS:Twenty-one patients underwent TIPS and the technical success rate was 100%,with no technical complications.Sixteen patients underwent recanalization of the IVC and/or HVs and the technical success rate was 100%.The mean procedure time for TIPS was 84.0±12.11 min and angioplasty was44.11±5.12 min(P<0.01).The mean portosystemic pressure in the TIPS group decreased significantly from 40.50±4.32 to 16.05±3.50 mm Hg(P<0.01).The mean portosystemic pressure gradient decreased significantly from 33.60±2.62 to 7.30±2.21 mm Hg(P<0.01).At 8 wk after the procedures,in the TIPS group,total bilirubin(TBIL)decreased significantly from 266.24±122.03 before surgery to 40.11±3.52μmol/L(P<0.01)and direct bilirubin(DBIL)decreased significantly from 194.22±69.82μmol/L to 29.82±3.10μmol/L(P<0.01).In the angioplasty group,bilirubin returned to the normal range,with TBIL decreased significantly from 258.22±72.71μmol/L to 13.33±3.54μmol/L(P<0.01)and DBIL from175.08±39.27 to 4.03±1.74μmol/L(P<0.01).Liver function improved faster than TBIL.After 2 wk,in the TIPS group,alanine aminotransferase(ALT)decreased significantly from 50.33±40.61 U/L to 28.67±7.02U/L(P<0.01)and aspartate aminotransferase(AST)from 49.46±34.33 U/L to 26.89±8.68 U/L(P<0.01).In the angioplasty group,ALT decreased significantly from 51.56±27.90 to 14.22±2.59μmol/L(P<0.01)and AST from 60.66±39.89μmol/L to 8.18±1.89μmol/L(P<0.01).After mean follow-up of 12.6 mo,there was no recurrence of jaundice in either group.CONCLUSION:Severe jaundice is not a contraindication for TIPS in patients with acute BCS and TIPS is appropriate for severe jaundice due to BCS.展开更多
文摘AIM: To evaluate combination transjugular intrahepatic portosystemic shunt(TIPS) and other interventions for hepatocellular carcinoma(HCC) and portal hypertension.METHODS: Two hundred and sixty-one patients with HCC and portal hypertension underwent TIPS combined with other interventional treatments(transarterial chemoembolization/transarterial embolization,radiofrequency ablation,hepatic arterio-portal fistulas embolization,and splenic artery embolization) from January 1997 to January 2010 at Beijing Shijitan Hospital. Two hundred and nine patients(121 male and 88 female,aged 25-69 years,mean 48.3 ± 12.5 years) with complete clinical data were recruited. We evaluated the safety of the procedure(procedurerelated death and serious complications),change of portal vein pressure before and after TIPS,symptom relief [e.g.,ascites,hydrothorax,esophageal gastricfundus variceal bleeding(EGVB)],cumulative rates of survival,and distributary channel restenosis. The characteristics of the patients surviving ≥ 5 and < 5 years were also analyzed.RESULTS: The portosystemic pressure was decreased from 29.0 ± 4.1 mm Hg before TIPS to 18.1 ± 2.9 mm Hg after TIPS(t = 69.32,P < 0.05). Portosystemic pressure was decreased and portal hypertension symptoms were ameliorated. During the 5 year followup,the total recurrence rate of resistant ascites or hydrothorax was 7.2%(15/209); 36.8%(77/209) for EGVB; and 39.2%(82/209) for hepatic encephalopathy. The cumulative rates of distributary channel restenosis at 1,2,3,4,and 5 years were 17.2%(36/209),29.7%(62/209),36.8%(77/209),45.5%(95/209) and 58.4%(122/209),respectively. No procedure-related deaths and serious complications(e.g.,abdominal bleeding,hepatic failure,and distant metastasis) occurred. Moreover,Child-Pugh score,portal vein tumor thrombosis,lesion diameter,hepatic arterio-portal fistulas,HCC diagnosed before or after TIPS,stent type,hepatic encephalopathy,and type of other interventional treatments were related to 5 year survival after comparing patient characteristics.CONCLUSION: TIPS combined with other interventional treatments seems to be safe and efficacious in patients with HCC and portal hypertension.
文摘AIM:To evaluate the feasibility of transjugular intrahepatic portosystemic shunt(TIPS)for severe jaundice secondary to acute Budd-Chiari syndrome(BCS).METHODS:From February 2009 to March 2013,37patients with severe jaundice secondary to acute BCS were treated.Sixteen patients without hepatic venule,hepatic veins(HV)obstruction underwent percutaneous angioplasty of the inferior vena cava(IVC)and/or HVs.Twenty-one patients with HV occlusion underwent TIPS.Serum bilirubin,liver function,demographic data and operative data of the two groups of patients were analyzed.RESULTS:Twenty-one patients underwent TIPS and the technical success rate was 100%,with no technical complications.Sixteen patients underwent recanalization of the IVC and/or HVs and the technical success rate was 100%.The mean procedure time for TIPS was 84.0±12.11 min and angioplasty was44.11±5.12 min(P<0.01).The mean portosystemic pressure in the TIPS group decreased significantly from 40.50±4.32 to 16.05±3.50 mm Hg(P<0.01).The mean portosystemic pressure gradient decreased significantly from 33.60±2.62 to 7.30±2.21 mm Hg(P<0.01).At 8 wk after the procedures,in the TIPS group,total bilirubin(TBIL)decreased significantly from 266.24±122.03 before surgery to 40.11±3.52μmol/L(P<0.01)and direct bilirubin(DBIL)decreased significantly from 194.22±69.82μmol/L to 29.82±3.10μmol/L(P<0.01).In the angioplasty group,bilirubin returned to the normal range,with TBIL decreased significantly from 258.22±72.71μmol/L to 13.33±3.54μmol/L(P<0.01)and DBIL from175.08±39.27 to 4.03±1.74μmol/L(P<0.01).Liver function improved faster than TBIL.After 2 wk,in the TIPS group,alanine aminotransferase(ALT)decreased significantly from 50.33±40.61 U/L to 28.67±7.02U/L(P<0.01)and aspartate aminotransferase(AST)from 49.46±34.33 U/L to 26.89±8.68 U/L(P<0.01).In the angioplasty group,ALT decreased significantly from 51.56±27.90 to 14.22±2.59μmol/L(P<0.01)and AST from 60.66±39.89μmol/L to 8.18±1.89μmol/L(P<0.01).After mean follow-up of 12.6 mo,there was no recurrence of jaundice in either group.CONCLUSION:Severe jaundice is not a contraindication for TIPS in patients with acute BCS and TIPS is appropriate for severe jaundice due to BCS.