Unsatisfactory outcomes of prolonged ischemic priapism without early surgical^shunts： our clinical experience and a review of the literature

Ischemic priapism is a rare occurrence which can cause severe erectile dysfunction （ED） without timely treatment. This retrospective study reports our experience in treating prolonged ischemic priapism and proposes our further considerations. In this paper, a total of nine patients with prolonged ischemic priapism underwent one to three types of surgical shunts, including nine Winter shunts, two AI-Ghorab shunts and one Grayhack shunt. During the follow-up visit （after a mean of 21.11 months）, all patients＇ postoperative characters were recorded, except one patient lost for death. Six postoperative patients accepted a 25-mg oral administration of sildenafil citrate. The erectile function of the patients was evaluated by their postoperative 5-item version of International Index of Erectile Function Questionnaire （IIEF-5）, which were later compared with their premorbid scores. All patients had complete resolutions, and none relapsed. The resolution rate was 100%. Seven patients were resolved with Winter shunts, one with an AI-Ghorab shunt and one with a Grayhack shunt. The mean hospital stay was 8.22 days. There was only one urethral fistula, and the incidence of postoperative ED was 66.67%. Four patients with more than a 72-h duration of priapism had no response to the long-term phosphodiesterase type 5 （PDE-5） inhibitor treatment. These results suggest that surgical shunts are an efficient approach to make the penis flaccid after prolonged priapism. However, the severe ED caused by prolonged duration is irreversible, and long-term PDE-5 inhibitor treatments are ineffective. Thus, we recommend early penile prosthesis surgeries for these patients.

Effect of rapamycin on hepatic osteodystrophy in rats with portasystemic shunting

AIM： TO study if T-cell activation related to portasystemic shunting causes osteoclast-mediated bone loss through RANKL-dependent pathways. We also investigated if T-cell inhibition using rapamycin would protect against bone loss in rats. METHODS： Portasystemic shunting was performed in male Sprague-Dawley rats and rapamycin 0.1 mg/kg was administered for 15 wk by gavage. Rats received powderized chow and supplemental feeds to prevent the effects of malnutrition on bone composition. Weight gain and growth was restored after surgery in shunted animals. At termination, biochemical parameters of bone turnover and quantitative bone histology were assessed. Markers of T-cell activation, inflammatory cytokine production, and RANKL-dependent pathways were measured. In addition, the roles of IGF-1 and hypogonadism were investigated. RESULTS： Portasystemic shunting caused low turnover osteoporosis that was RANKL independent. Bone resorbing cytokine levels, including IL-1, IL-6 and TNFα, were not increased in serum and TNFα and RANKL expression were not upregulated in PBMC. Portasystemic shunting increased the circulating CD8＋ T-cell population. Rapamycin decreased the circulating CD8＋ T-cell population, increased CD8＋ CD25＋ T-regulatory cell population and improved all parameters of bone turnover. CONCLUSION： Osteoporosis caused by portasystemic shunting may be partially ameliorated by rapamycin in the rat model of hepatic osteodystrophy.

Ductus Arteriosus Stent Compared with Surgical Shunt for Infants with Ductal-Dependent Pulmonary Blood Flow: A Systematic Review and Meta-Analysis

The aim of this study was to perform a systematic review and meta-analysis to evaluate the safety and efficacy of ductus arteriosus stent(DAS)compared with surgical systemic-pulmonary artery shunt(SPS)in patients with ductal-dependent pulmonary blood flow.A literature search was conducted in PubMed,Embase,and the Cochrane Library databases from their inception to December 2020.Two reviewers independently screened the articles,evaluated the quality of the articles,and collected the data.Meta-analyses were conducted using fixed and random effects models.We used the I-square(I2)test to examine heterogeneity and the funnel plot Egger’s test was used to test for publication bias.We analyzed nine studies including 842 patients were included in the present study(DAS:n=295;SPS:n=547).There was a benefit in favor of DAS group for medium-term mortality(RR,0.63;95%CI,[0.40,0.99];P=0.91,I^(2)=0%).DAS group demonstrated a reduced risk for complications compared with SPS(RR,0.46;95%CI,[0.29,0.72];P=0.78,I^(2)=0%).There was an increased risk for unplanned reintervention for DAS(RR,1.77;95%CI,[1.42,2.20];P=0.61,I2=0%).DAS demonstrated shorter mean intensive care unit length of stay(MD,–5.12;95%CI,[–7.33,–2.91];P=0.005,I^(2)=76%).There was also demonstrated higher postprocedure oxygen saturation for SPS over DAS(MD,1.78;95% CI,[0.92,2.64];P=0.46,I2=0%).There was no difference between the two groups in terms of mortality within 30 days,Nakata Index,and hospital length of stay.Conclusions:In terms of initial palliative surgical in the ductal-dependent pulmonary blood flow,DAS demonstrated a lower risk of medium-term mortality,lower risk of complications,higher risk of unplanned reintervention,shorter ICU length of stay,and higher postprocedure oxygen saturation compared with SPS.

Priapism secondary to chronic myeloid leukemia treated by a surgical cavernosa-corpus spongiosum shunt: Case report

Priapism secondary to chronic myeloid leukemia(CML)is rarely observed in the clinic.Here,we present an 18-year-old patient with priapism for over 72 h due to hyperleukocytosis.Emergent interventions such as therapeutic aspiration and intracorporal injection of phenylephrine failed before a surgical corpora cavernosa-corpus spongiosum shunt was inserted to relieve symptoms.During hospitalization,bone marrow aspiration confirmed the diagnosis of CML.

Progress and Prospects of Surgical Treatment of Portal Hypertension

Portal hypertension is a group of syndrome characterized by splenic hyperfunction, esophageal and gastric varices and ascites caused by abnormal portal vein hemodynamics. Among them, upper gastrointestinal bleeding caused by esophageal and gastric varices is the most dangerous complication, which often threatens the lives of patients. After half a century of development, the treatment of portal hypertension is divided into two categories: medical drug therapy, endoscopic therapy and surgical treatment. With the understanding of portal hypertension and the continuous development of medical technology, the surgical operation of portal hypertension has also been greatly improved, reducing postoperative complications and improving the quality of life of patients after operation. However, at present, there is no surgical method that can completely cure portal hypertension. This article reviews the progress of surgical treatment of portal hypertension in recent years, in order to provide reference for the surgical treatment of portal hypertension.

Evaluation of surgical procedure selection based on intraoperative free portal pressure measurement in patients with portal hypertension

BACKGROUND: Various surgical procedures can be used to treat liver cirrhosis and portal hypertension. How to select the most appropriate procedure for patients with portal hypertension has become a difficult problem. This study aimed to analyze the relationship between the value of intraoperative free portal pressure (FPP) and postoperative complications, and to explore the significance of intraoperative FPP measurement with respect to surgical procedure selection. METHODS: The clinical data of 187 patients with portal hypertension who received pericardial devascularization and proximal splenorenal shunt combined with devascularization (combined operation) at the Department of General Surgery in our hospital from January 2001 to September 2008 were retrospectively analyzed. Among the patients who received pericardial devascularization, those with a postoperative FPP >= 22 mmHg were included in a high-pressure group (n=68), and those with FPP <22 mmHg were in a low-pressure group (n=49). Seventy patients who received the combined operation comprised a combined group. The intraoperative FPP measurement changes at different times, and the incidence of postoperative complications in the three groups of patients were compared. RESULTS. The postoperative FPP value in the high-pressure group was 27.5 +/- 2.3 mmHg, which was significantly higher than that of the low-pressure (20.9 +/- 1.8 mmHg) or combined groups (21.7 +/- 2.5 mmHg). The rebleeding rate in the high-pressure group was significantly higher than that in the low-pressure and combined groups. The incidence rates of postoperative hepatic encephalopathy and liver failure were not statistically different among the three groups. The mortality due to rebleeding in the low-pressure and combined groups (0.84%) was significantly lower than that of the high-pressure group. CONCLUSIONS: The study demonstrates that FPP is a critical measurement for surgical procedure selection in patients with portal hypertension. A FPP value >= 22 mmHg after splenectomy and devascularization alone is an important indicator that an additional proximal splenorenal shunt needs to be performed. (Hepatobiliary Pancreat Dis Int 2010; 9: 269-274)

Clinical analysis of surgical treatment of portal hypertension

AIM： To review the experience in surgery for 508 patients with portal hypertension and to explore the selection of reasonable operation under different conditions. METHODS： The data of 508 patients with portal hypertension treated surgically in 1991-2001 in our centers were analyzed. Of the 508 patients, 256 were treated with portaazygous devascularization （PAD）, 167 with portasystemic shunt （PSS）, 62 with selective shunt （SS）, 11 with combined portasystemic shunt and portaazygous devascularization （PSS＋PAD）, 9 with liver transplantation （LT）, 3 with union operation for hepatic carcinoma and portal hypertension （HCC＋PH）. RESULTS： In the 167 patients treated with PSS, free portal pressure （FPP） was significantly higher in the patients with a longer diameter of the anastomotic stoma than in those with a shorter diameter before the operation （P〈0.01）. After the operation, FPP in the former patients markedly decreased compared to the latter ones （P〈0.01）. The incidence rate of hemorrhage in patients treated with PAD, PSS, 55, PSS＋PAD, and HCC＋PH was 21.09% （54/256）, 13.77 （23/167）, 11.29 （7/62）, 36.36% （4/11）, and 100% （3/3）, respectively. The incidence rate of hepatic encephalopathy was 3.91% （10/256）, 9.58% （16/167）, 4.84% （3/62）, 9.09% （1/11）, and 100% （3/3）, respectively while the operative mortality was 5.49% （15/256）, 4.22% （7/167）, 4.84% （3/62）, 9.09% （1/11）, and 66.67% （2/3） respectively. The operative mortality of liver transplantation was 22.22% （2/9）. CONCLUSION： Five kinds of operation in surgical treatment of portal hypertension have their advantages and disadvantages. Therefore, the selection of operation should be based on the actual needs of the patients.

Transcatheter Closure of Postoperative Residual Atrial or Ventricular Septal Shunts in Patients with Congenital Heart Disease

Background:Transcatheter closure(TCC)has emerged as the preferred treatment for selected congenital heart disease(CHD).While TCC offers benefits for patients with postoperative residual shunts,understanding its mid-and long-term efficacy and safety remains crucial.Objective:This study aims to assess the mid-and long-term safety and efficacy of TCC for patients with residual atrial or ventricular septal shunts following CHD correction.Methods:In this consecutive retrospective study,we enrolled 35 patients with residual shunt who underwent TCC or surgical repair of CHD between June 2011 to October 2022.TCC candidacy was determined based on established criteria.Echocardiography and electrocardiogram were conducted during the perioperative period and continued as part of long-term follow-up.Results:Among the patients,5(14.3%)exhibited interatrial shunt-ing,while 30(85.7%)had interventricular shunting.TCC was successfully implemented in 33 of 35 patients,with exceptions in two cases of post-ventricular septal defect repair due to anatomical challenges involving the shape and aortic angulation.This resulted in a TCC success rate of 94.3%.Trace residual shunt was detected in two interventricular shunting cases and a mild residual shunt in one interventricular shunting case;all resolved by the three-month follow-up after TCC.Minor complications included one hematoma at the puncture site and one transient junctional rhythm during the perioperative period.During a median follow-up of 73 months,there were no instances of residual shunt,device embolization,occluder displacement,valve insufficiency,malignant arrhythmia,infective endocarditis,death,or other serious complications.Conclusion:TCC is an effective and safe therapy for patients with residual atrial or ventricular septal shunts following CHD correction.Thesefindings support the consideration of TCC as the preferred treatment option for appropriate patient populations.

Transjugular Intrahepatic Portosystemic Shunt Versus Surgical Shunting in the Management of Portal Hypertension

Background:The purpose of this article was to clarify the optimal management concerning transjugular intrahepatic portosystemic shunts (TIPSs) and surgical shunting in treating portal hypertension.Methods:All databases,including CBM,CNKI,WFPD,Medline,EMBASE,PubMed and Cochrane up to February 2014,were searched for randomized controlled trials (RCTs) comparing TIPS with surgical shunting.Four RCTs,which were extracted by two independent investigators and were evaluated in postoperative complications,mortality,2-and 5-year survival,hospital stay,operating time and hospitalization charges.Results:The morbidity in variceal rehemorrhage was significantly higher in TIPS than in surgical shunts (odds ratio [OR] =7.45,95％confidence interval [CI]:(3.93-14.15),P ＜ 0.00001),the same outcomes were seen in shunt stenosis (OR =20.01,95％ CI:(6.67-59.99),P ＜ 0.000001) and in hepatic encephalopathy (OR =2.50,95％ CI:(1.63-3.84),P ＜ 0.0001).Significantly better 2-year survival (OR =0.66;95％ CI:(0.44-0.98),P =0.04) and 5-year survival (OR =0.44; 95％ CI:(0.30-0.66),P ＜ 0.00001) were seen in patients undergoing surgical shunting compared with TIPS.Conclusions:Compared with TIPS,postoperative complications and survival after surgical shunting were superior for patients with portal hypertension.Application of surgical shunting was recommended for patients rather than TIPS.

Surgical method of lateral ventriculo-superior sagittal sinus shunt surgery for hydrocephalus

From August 2016 to June 2018, a total of 7 patients underwent lateral ventriculo-superior sagittal shunt surgeries in our hospital. All cases were followed up for 3 months to 2 years after the surgeries. The results of their head CT scans or MRI scans indicated that the conition of hydrocephalus generally improved, and the symptoms of intracranial hypertension significantly improved or disappeared. The superior sagittal sinus shunt surgery for hydrocephalus is simple to operate and also safe and effective, and it's an important method of treatment for hydrocephalus. This article described the specific surgical procedure for lateral ventriculo-superior sagittal shunt surgery in detail so that this surgical procedure can be better promoted.

Side effects of budesonide in liver cirrhosis due to chronic autoimmune hepatitis: Influence of hepatic metabolism versus portosystemic shunts on a patient complicated with HCC

AIM:To investigate the systemic availability of budesonide in a patient with Child A cirrhosis due to autoimmune hepatitis (AIH) and primary hepatocellular carcinoma,who developed serious side effects. METHODS:Serum levels of budesonide,6β-OH-budesonide and 16α-OH-prednisolon were measured by HPLC/MS/MS; portosystemic shunt-index (SI) was determined by 99mTc nuclear imaging.All values were compared with a matched control patient without side effects. RESULTS:Serum levels of budesonide were 13-fold increased in the index patient.The ratio between serum levels of the metabolites 6β-OH-budesonide and 16α-OH- prednisolone,respectively,and serum levels of budesonide was diminished (1.0 vs.4.0 for 6β-OH-budesonide,4.2 vs. 10.7 for 16α-OH-prednisolone).Both patients had portosystemic SI (5.7 % and 3.1%) within the range of healthy subjects.CONCLUSION:Serum levels of budesonide Vary uP to 13-fold in AIH Patients with Child A eirrhosis in the absenee ofrelevant Portosystemic shunting.Redueed hePatiemetabolism,as indicated by redueed metabolite-to-drugratio,rather than Portosystemie shunting may explainsystemic side effects of this drug in cirrhosis

肝硬化食管胃底静脉曲张破裂出血患者经颈静脉肝内门体分流术后非计划再入院的危险因素分析及列线图模型构建

目的探讨经颈静脉肝内门体分流术(TIPS)的肝硬化食管胃底静脉曲张破裂出血患者出院30 d内发生非计划再入院危险因素,并构建风险预测列线图模型。方法选取2020年1月—2023年6月在南京大学医学院附属鼓楼医院因肝硬化食管胃底静脉曲张破裂出血行TIPS的241例患者作为研究对象。分析患者30 d内非计划再入院情况,并依据是否发生非计划再入院分为再入院组(n=36)和未再入院组(n=198)。收集患者临床资料,符合正态分布的计量资料2组间比较采用成组t检验,偏态分布的计量资料2组间比较采Mann-Whitney U检验;计数资料2组间比较采用χ^(2)检验。Logistic回归分析筛选出与非计划再入院相关的独立危险因素。建立列线图预测模型,绘制受试者工作特征曲线(ROC曲线)评估列线图模型预测非计划再入院发生的区分度;绘制校准曲线评估列线图模型预测非计划再入院发生的一致性,采用R语言Resource Selection包进行Hosmer-Lemeshow评估模型的拟合度,决策曲线分析评估模型的实用性。结果年龄(OR=2.664,95%CI:1.139~6.233)、CTP评分(OR=1.655,95%CI:1.098~2.495)、血氨(OR=1.032,95%CI:1.016~1.048)是行TIPS患者出院30 d内非计划再入院的独立危险因素(P值均<0.05)。依据多因素分析结果,构建风险预测列线图模型,通过Bootstrap法重复抽样1000次展开内部验证,ROC曲线下面积为0.773,高于年龄(0.582)、CTP评分(0.675)、血氨(0.641),校准曲线显示列线图模型预测非计划再入院的概率与实际概率具有较好一致性,Hosmer-Lemeshow显示拟合优度良好(χ^(2)=5.6473,P=0.6867)。结论年龄、CTP评分和血氨是TIPS术后30 d非计划再入院的独立危险因素,以此建立的列线图预测模型有助于预测行TIPS患者非计划再入院发生风险,为早期预防提供较为准确的决策依据。

Could there be light at the end of the tunnel? Mesocaval shunting for refractory esophageal varices in patients with contraindications to transjugular intrahepatic portosystemic shunt

Cirrhotic patients with recurrent variceal bleeds who have failed prior medical and endoscopic therapies and are not transjugular intrahepatic portosystemic shunt candidates face a grim prognosis with limited options. We propose that mesocaval shunting be offered to this group of patients as it has the potential to decrease portal pressures and thus decrease the risk of recurrent variceal bleeding. Mesocaval shunts are stent grafts placed by interventional radiologists between the mesenteric system, most often the superior mesenteric vein, and the inferior vena cava. This allows flow to bypass the congested hepatic system, reducing portal pressures. This technique avoids the general anesthesia and morbidity associated with surgical shunt placement and has been successful in several case reports. In this paper we review the technique, candidate selection, potential pitfalls and benefits of mesocaval shunt placement.

结扎脐旁静脉缓解TIPS后肝性脑病1例

患者男,57岁,黑便3天;腹胀1年余,经多次利尿、腹腔积液抽取等内科保守治疗效果不佳;罹患乙型肝炎肝硬化20余年。查体:贫血貌,结膜苍白,腹膨隆,腹壁静脉曲张。实验室检查:血红蛋白72 g/L,胆红素31.6μmol/L,凝血酶原时间15.5 s,血氨32μmol/L。腹部增强CT提示肝硬化、门静脉高压、脾大、腹盆腔大量积液、腹壁静脉曲张。胃镜示食管胃底静脉重度曲张伴红色征;行胃镜下曲张静脉套扎及硬化治疗。

Effects of combined splenorenal shunt devascularization and devascularization only on hemodynamics of the portal venous system in patients with portal hypertension

Shunt and devascularization have totally different effects on hemodynamics of the portal venous system , and the actual results of combined shunt and devascularization should be determined by more clinical observations. This study aimed to evaluate effects on hemodynamics of the portal venous system after conventional spleno-renal shunt combined with pericardial devascularization and pericardial devascularization only. METHODS: In 20 patients who had received conventional splenorenal shunt combined with pericardial devascularization(CP) and 18 who had received pericardial devascularization and splenectomy (PCDV), hemodynamic parameters of the portal venous system were studied by magnetic resonance angiography 1 week before and 2 weeks after operation. Free portal pressure was detected continuously by a transducer during the operation. RESULTS: Compared to the preoperative data, a decreased flow of the portal vein (PVF) (563.12±206.42 ml/min vs 1080.63±352.85 ml/min, P<0.05), a decreased diameter of the portal vein (PVD) (1.20±0.11 cm vs 1.30±0.16 cm, P<0.01 ), a decreased free portal preasure ( FPP ) (21.50±2.67 mmHg vs 29.88±2.30 mmHg, P<0.01) and an increased flow of the superior mesenteric vein (SMVF) (1105.45±309.03 ml/min vs 569.13±178.46 ml/min, P < 0.05) were found in the CP group after operation; a decreased PVD (1.27±0.16 cm vs 1.40±0.23 cm, P<0.05), a decreased PVF (684.60±165.73 ml/min vs 1175.64±415.09 ml/min, P<0.05), a decreased FPP (24.40±3.78 mmHg vs 28.80±3.56 mmHg, P<0.05) and an increased SMVF (697.91+121.83 ml/min vs 521.30±115.82 ml/min, P<0.05) were found in the PCDV group. After operation, the PVF of CP group (563.12±206.42 ml/min vs 684.60±165.73 ml/min, P>0.05) was not decreased significantly while FPP (21.50±2.67 mmHg vs 24.40±3.78 mmHg, P< 0.01) was decreased significantly as compared with that of the PCDV group. PVF and FPP could be decreased by both surgical procedures, but the effect of decreasing FPP is much better in the combined procedures than in PCDV. Since there is no significant difference in PVF between the two groups, the combined procedures could integrate advantages of shunt with those of the devascularization, maintaining the normal anatomy structure of the hepatic portal vein, and should be one of the best choices for patients with PHT when surgical interventions are considered.

产前超声诊断胎儿VACTERL联合征合并肝内门-腔静脉分流1例

孕妇25岁,孕3产1;孕25^(+5)周产前超声提示胎儿发育异常,无家族遗传病史及不良孕产史。产科查体及实验室检查无特殊。产前超声:胎儿生长发育与孕周相符,胎心率148次/分;C3为半椎体(图1A),左侧第10、11肋间隙变窄(图1B),T_(6-7)椎间隙变窄;室间隔上部回声连续性中断约0.30cm,心室水平见过隔血流信号(图1C);食管上段盲袋样扩张,宽约0.80cm;胃泡充盈差。

Comparison of a new stent and Wallstent for transjugular intrahepatic portosystemic shunt in a porcine model

AIM: To evaluate a new balloon-expandable stainless steel stent (Cordis stent) in a transjugular intrahepatic portosystemic shunt (TIPS) porcine model and compared with Wallstent. METHODS: TIPS was performed in 26 normal domestic pigs weighing 20 kg-30 kg using a Cordis stent or Wallstent (13 pigs in each stent). All pigs were sacrificed at the 14th day after TIPS. The stent deployment delivery system, stent patency, and stent recoil after placement were evaluated.Proliferative response in representative histological sections from the center,hepatic and portal regions of the two stent designs were quantified. RESULTS: The shunt was widely patent in 4 pigs in the Cordis stent group (4/12, premature dead in 1 pig), and in 5 pigs in the Wallstent group (5/13). All remaining stents of both designs were occluded or stenotic. The mean quantified proliferation including thickness of the proliferation and the ratio of proliferation: total area in three assayed regions in Cordis stent and Wallstent was 2.18 mm:2.00 mm, and 59.18 mm2:51.66 mm2, respectively (P 】 0.05). The delivery system and mechanical properties of the Cordis stent functioned well. CONCLUSION: The new Cordis stent is appropriate for TIPS procedure.

Transjugular portosystemic stent shunt in treatment of liver diseases

INTRODUCTIONMore than 10 years ago ,an interventional technique for the creation of an intrahepatic decompressive shunt between a branch of the portal vein and a main hepatic vein using expandable metallic stents has been intriduced for the treatmint of portal hypertension[1,2],This transjugular portosystemic intrahepatic stent shunt (TIPS) functions as a side to side shunt ,similarly to surgical shunts .

Peritoneovenous shunt for intractable ascites due to hepatic lymphorrhea after hepatectomy

A peritoneovenous shunt has become one of the most effi cient procedures for intractable ascites due to liver cirrhosis.A case of intractable ascites due to hepatic lymphorrhea after hepatectomy for hepatocellular carcinoma that was successfully treated by the placement of a peritoneovenous shunt is presented.A 72-year-old Japanese man underwent partial resection of the liver for hepatocellular carcinoma associated with hepatitis C viral infection.After hepatectomy,a considerable amount of ascites ranging from 800-4600 mL per day persisted despite conservative therapy,including numerous infusions of albumin and plasma protein fraction and administration of diuretics.Since the patient's general condition deteriorated,based on the diagnosis of intractable hepatic lymphorrhea,a subcutaneous peritoneovenous shunt was inserted.The patient's postoperative course was uneventful and the ascites decreased rapidly,with serum total protein and albumin levels and hepatic function improving accordingly.For intractable ascites due to hepatic lymphorrhea after hepatectomy,we recommend the placement of a peritoneovenous shunt as a procedure that can provide immediate effectiveness without increased surgical risk.

肝硬化食管胃底静脉曲张破裂出血患者经颈静脉肝内门体分流术后发生显性肝性脑病的列线图预测模型建立及评价

目的构建肝硬化食管胃底静脉曲张破裂出血后行经颈静脉肝内门体分流术(TIPS)患者发生显性肝性脑病的预测模型列线图,并对模型预测能力进行评价。方法选取苏州大学附属第一医院2020年1月—2022年12月收治的因肝硬化食管胃底静脉曲张破裂出血经药物治疗或内镜下止血失败后行TIPS的患者113例,所有患者术后随访6个月,根据TIPS术后是否发生显性肝性脑病,分为显性肝性脑病组(n=32)和非显性肝性脑病组(n=81),收集患者的临床资料、血常规、血清生化学及血凝检查等结果。计量资料两组间比较采用成组t检验或Mann-Whitney U检验。计数资料组间比较采用χ^(2)检验或Fisher精确概率法。利用多因素Logistic回归法分析TIPS术后肝性脑病发生的独立影响因素,并构建列线图预测模型,计算一致性指数(C-index)并绘制校准曲线,评价列线图预测能力。绘制临床决策曲线,分析模型临床净收益。通过受试者工作特征曲线(ROC曲线)对模型的预测能力进行验证。结果显性肝性脑病组与非显性肝性脑病组比较,年龄、糖尿病、ChildPugh分级、腹水、术前门静脉主干直径、GGT水平、凝血酶原时间及弗赖堡术后生存指数(FIPS)评分差异均有统计学意义(P值均<0.05)。多因素Logistic回归分析结果显示,Child-Pugh分级(OR=17.498,95%CI:2.561~119.548,P=0.004)、术前门静脉主干直径(OR=1.361,95%CI:1.057~1.752,P=0.017)、GGT(OR=1.032,95%CI:1.013~1.052,P=0.001)和FIPS评分(OR=2.838,95%CI:1.277~6.311,P=0.010)是TIPS术后发生显性肝性脑病的独立影响因素。基于以上4项指标建立列线图模型,C-index为0.875,校准曲线拟合良好;模型的ROC曲线下面积为0.875(95%CI:0.799~0.929,P<0.001);决策曲线分析结果显示,0.3~0.9阈概率间模型具有较良好的净获益。结论Child-Pugh分级、术前门静脉主干直径、GGT及FIPS评分对肝硬化食管胃底静脉曲张破裂出血患者TIPS术后显性肝性脑病的发生具有一定的预测价值,基于上述指标构建的列线图模型可以个体化预测肝硬化食管胃底静脉曲张破裂出血患者TIPS术后显性肝性脑病的发生率。