BACKGROUND As transjugular intrahepatic portosystemic shunt(TIPS)creation alters the hemodynamic status of the portal system,whether reduced portal blood supply affects the synthetic reserve function of the liver has ...BACKGROUND As transjugular intrahepatic portosystemic shunt(TIPS)creation alters the hemodynamic status of the portal system,whether reduced portal blood supply affects the synthetic reserve function of the liver has been the focus of clinical attention.Since the Viatorr stent entered the Chinese market in 2015,it has not yet been widely used in clinical practice.Further,unlike other countries,the main cause of liver cirrhosis in China is viral hepatitis.Therefore,use of the Viatorr stent to establish a TIPS channel in patients with liver cirrhosis with differing etiologies is of great clinical interest.AIM To investigate factors affecting changes in liver reserve function after TIPS Viatorr stent implantation.METHODS Clinical data from 200 patients with cirrhotic portal hypertension who received TIPS treatment from March 2016 to March 2020 were analyzed retrospectively.The patients were divided into three groups(A-C),according to their disease etiology,with post-hepatitis,autoimmune,and alcoholic cirrhosis,respectively.Preoperative and postoperative liver and renal function and coagulation data,Child-Pugh grade,and model for end-stage liver disease(MELD)scores were collected.Statistical analyses were performed using the t-test or chi-square test.The incidence and of hepatic encephalopathy and patient survival were calculated using Kaplan-Meier method.RESULTS The surgical success rate was 100%,with mean portal pressure gradient(mmHg)decreasing from 25.5±5.22 to 10.04±2.76(t=45.80;P<0.001).After 24 mo,the cumulative incidence of hepatic encephalopathy in group A was significantly lower than that in group B/C,while the cumulative survival rate was significantly higher in group A than in group B/C(P<0.05 for both).The Child-Pugh score for group A was 6.96±1.21,which was significantly better than those of groups B(7.42±0.99;t=-2.44;P=0.016)and C(7.52±1.12;t=-2.67;P=0.009).Further,the MELD score for group A(9.62±2.19)was significantly better than those for groups B(10.64±1.90;t=-2.92;P=0.004)and C(10.82±2.01;t=-3.29;P=0.001).CONCLUSION Insertion of 8 mm internal diameter Viatorr stent has no significant effects on liver reserve function.Changes of liver reserve function in the medium and long term may be related to the etiology and treatment of portal hypertension.展开更多
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 ...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.展开更多
报告使用Viatorr支架完成经颈静脉肝内门腔静脉分流术3例,并结合文献讨论该支架的特点,置入过程的操作要点。3例患者均为肝硬化并门静脉高压症,食管静脉曲张破裂出血。3例患者均成功完成经颈静脉肝内门腔静脉分流术,术前3例患者门静脉...报告使用Viatorr支架完成经颈静脉肝内门腔静脉分流术3例,并结合文献讨论该支架的特点,置入过程的操作要点。3例患者均为肝硬化并门静脉高压症,食管静脉曲张破裂出血。3例患者均成功完成经颈静脉肝内门腔静脉分流术,术前3例患者门静脉压力分别为30.1、32.4、42.6 mm Hg,术后门静脉压力分别下降至21.3、17.7、26.5 mm Hg。随访期间均无肝性脑病发生,彩超检查显示支架内血流通畅。使用Viatorr支架可以成功完成经颈静脉肝内门腔静脉分流术。展开更多
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...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.展开更多
文摘BACKGROUND As transjugular intrahepatic portosystemic shunt(TIPS)creation alters the hemodynamic status of the portal system,whether reduced portal blood supply affects the synthetic reserve function of the liver has been the focus of clinical attention.Since the Viatorr stent entered the Chinese market in 2015,it has not yet been widely used in clinical practice.Further,unlike other countries,the main cause of liver cirrhosis in China is viral hepatitis.Therefore,use of the Viatorr stent to establish a TIPS channel in patients with liver cirrhosis with differing etiologies is of great clinical interest.AIM To investigate factors affecting changes in liver reserve function after TIPS Viatorr stent implantation.METHODS Clinical data from 200 patients with cirrhotic portal hypertension who received TIPS treatment from March 2016 to March 2020 were analyzed retrospectively.The patients were divided into three groups(A-C),according to their disease etiology,with post-hepatitis,autoimmune,and alcoholic cirrhosis,respectively.Preoperative and postoperative liver and renal function and coagulation data,Child-Pugh grade,and model for end-stage liver disease(MELD)scores were collected.Statistical analyses were performed using the t-test or chi-square test.The incidence and of hepatic encephalopathy and patient survival were calculated using Kaplan-Meier method.RESULTS The surgical success rate was 100%,with mean portal pressure gradient(mmHg)decreasing from 25.5±5.22 to 10.04±2.76(t=45.80;P<0.001).After 24 mo,the cumulative incidence of hepatic encephalopathy in group A was significantly lower than that in group B/C,while the cumulative survival rate was significantly higher in group A than in group B/C(P<0.05 for both).The Child-Pugh score for group A was 6.96±1.21,which was significantly better than those of groups B(7.42±0.99;t=-2.44;P=0.016)and C(7.52±1.12;t=-2.67;P=0.009).Further,the MELD score for group A(9.62±2.19)was significantly better than those for groups B(10.64±1.90;t=-2.92;P=0.004)and C(10.82±2.01;t=-3.29;P=0.001).CONCLUSION Insertion of 8 mm internal diameter Viatorr stent has no significant effects on liver reserve function.Changes of liver reserve function in the medium and long term may be related to the etiology and treatment of portal hypertension.
基金Medical scientific research project of Sichuan province,China (No.S18014)
文摘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.
文摘报告使用Viatorr支架完成经颈静脉肝内门腔静脉分流术3例,并结合文献讨论该支架的特点,置入过程的操作要点。3例患者均为肝硬化并门静脉高压症,食管静脉曲张破裂出血。3例患者均成功完成经颈静脉肝内门腔静脉分流术,术前3例患者门静脉压力分别为30.1、32.4、42.6 mm Hg,术后门静脉压力分别下降至21.3、17.7、26.5 mm Hg。随访期间均无肝性脑病发生,彩超检查显示支架内血流通畅。使用Viatorr支架可以成功完成经颈静脉肝内门腔静脉分流术。
文摘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.
