[Therapeutic efficacy of transjugular intrahepatic portosystemic shunt on bleeding gastric varices].

Hee Gon Song, Han Chu Lee, Young Hwan Park, Saera Jung, Young-Hwa Chung, Yung Sang Lee, Hyun Ki Yoon, Kyu Bo Sung, Dong Jin Suh
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Abstract

Background/aims: Gastric variceal bleeding is a severe complication of liver cirrhosis with a high mortality. The purpose of this study was to determine the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in patients with gastric variceal bleedings and predictive factors for survival.

Methods: We retrospectively analyzed the medical records of 30 consecutive patients with gastric variceal bleedings from January 1998 to March 2001. The causes of cirrhosis were viral hepatitis in 17, alcohol in 12, and biliary cirrhosis in 1. Eighteen patients were in Child-Pugh class B and 9 in class C at the time of TIPS. The median follow-up period was 403 days (3-1,215 days).

Results: TIPS insertion was successful in all 30 patients. The portal pressure gradient (PPG) was significantly reduced from 23+/-8 mmHg to 11+/-5 mmHg (p<0.05). Hepatic encephalopathy, which developed in 3 patients and was aggravated in 1, was improved with medical therapy. Patients with non-alcoholic etiology experienced deterioration of liver function after TIPS. Those with alcoholic etiology did not. The 6-month and 1-year rebleeding rates were 22% and 41%, respectively. 56% of bleeding episodes were associated with stent dysfunction. The degree of PPG reduction and the development of stent dysfunction were independent predictive factors for rebleeding. The 6-month and 1-year survival rates were 83% and 79%. The causes of death were hepatic failure in 3 (37.5%), recurrent variceal bleeding in 3, and others in 2. Child-Pugh class C was the only prognostic factor for survival.

Conclusions: TIPS was effective in acute hemostasis and the prevention of rebleeding in patients with gastric variceal bleeding. Especially, it can be safely applied to patients with alcoholic etiology and in Child-Pugh class A or B.

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[经颈静脉肝内门静脉分流术治疗胃底静脉曲张出血的疗效]。
背景/目的:胃静脉曲张出血是肝硬化的严重并发症,死亡率高。本研究的目的是确定经颈静脉肝内门静脉系统分流术(TIPS)对胃静脉曲张出血患者的疗效和生存的预测因素。方法:回顾性分析1998年1月至2001年3月连续收治的30例胃静脉曲张出血患者的病历。肝硬化的原因有病毒性肝炎17例,酒精12例,胆汁性肝硬化1例。TIPS时18例为Child-Pugh B级,9例为C级。中位随访期为403天(3- 1215天)。结果:30例患者均成功插入TIPS。门静脉压力梯度(PPG)由23+/-8 mmHg显著降低至11+/-5 mmHg。结论:TIPS对胃静脉曲张出血患者的急性止血和预防再出血有较好的疗效。特别是,它可以安全地应用于酒精病因和Child-Pugh A级或B级的患者。
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