大型自发性门体分流术 (SPSS) 与经颈静脉肝内门体分流术 (TIPS) 患者的 HE 风险增加有关。本研究旨在评估在 TIPS 创建时预防性栓塞大 SPSS 是否可以降低肝硬化和静脉曲张出血患者 TIPS 后 HE 的发生率。

从 2014 年 6 月至 2017 年 8 月，56 名计划接受 TIPS 预防静脉曲张出血的肝硬化和大型 SPSS 患者被随机分配（1:1）接受单独的 TIPS（TIPS 组，n = 29）或 TIPS 加同时 SPSS 栓塞（TIPS+E 组，n = 27）。主要终点是明显的 HE。 TIPS 放置和 SPSS 栓塞在所有患者中均成功。在 24 个月的中位随访期间，TIPS 组的 15 名患者（51.7%）和 TIPS+E 组的 6 名患者（22.2%）达到了主要终点（p = 0.045）。与 TIPS 组相比，TIPS+E 组明显 HE 的 2 年累积发生率显着降低（21.2% 对 48.3%；HR，0.38；95% CI，0.15-0.97；p = 0.043）。复发性出血（TIPS+E vs. TIPS，15.4% vs. 25.1%；p = 0.522）、分流功能障碍（12.3% vs. 18.6%，p = 0.593）、死亡（15.0% vs. 6.9）的 2 年发生率%, p = 0.352)，其他不良事件在两组之间没有显着差异。

在接受 TIPS 治疗静脉曲张出血的肝硬化患者中，并发大 SPSS 栓塞可降低明显 HE 的风险，而不会增加其他并发症。因此，应考虑同时进行大型 SPSS 栓塞以预防 TIPS 后 HE。

Abstract

Background and aims: Large spontaneous portosystemic shunt (SPSS) is associated with increased risk of HE in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS). This study aimed to evaluate whether prophylactic embolization of large SPSS at the time of TIPS creation could reduce the incidence of post-TIPS HE in patients with cirrhosis and variceal bleeding.

Approach and results: From June 2014 to August 2017, 56 patients with cirrhosis and large SPSS planning to undergo TIPS for the prevention of variceal bleeding were randomly assigned (1:1) to receive TIPS alone (TIPS group, n = 29) or TIPS plus simultaneous SPSS embolization (TIPS+E group, n = 27). The primary endpoint was overt HE. TIPS placement and SPSS embolization was successful in all patients. During a median follow-up of 24 months, the primary endpoint was met in 15 patients (51.7%) in the TIPS group and six patients (22.2%) in the TIPS+E group (p = 0.045). The 2-year cumulative incidence of overt HE was significantly lower in the TIPS+E group compared with the TIPS group (21.2% vs. 48.3%; HR, 0.38; 95% CI, 0.15-0.97; p = 0.043). The 2-year incidence of recurrent bleeding (TIPS+E vs. TIPS, 15.4% vs. 25.1%; p = 0.522), shunt dysfunction (12.3% vs. 18.6%, p = 0.593), death (15.0% vs. 6.9%, p = 0.352), and other adverse events was not significantly different between the two groups.

Conclusions: In patients with cirrhosis treated with TIPS for variceal bleeding, concurrent large SPSS embolization reduced the risk for overt HE without increasing other complications. Concurrent large SPSS embolization should therefore be considered for prophylaxis of post-TIPS HE.

原文链接

https://pubmed.ncbi.nlm.nih.gov/35266571/

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