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| 1 | TIPS improves liver transplantation-free survival in cirrhotic patients with refractory ascites:An updated meta-analysis显示文摘AIM:To compare the liver transplantation-free(LTF)survival rates between patients who underwent transjugular intrahepatic portosystemic shunts(TIPS)and those who underwent paracentesis by an updated meta-analysis that pools the effects of both number of deaths and time to death.METHODS:MEDLINE,EMBASE,and the Cochrane Library were searched from the inception to October2012.LTF survival,liver transplantation,liver diseaserelated death,non-liver disease-related death,recurrent ascites,hepatic encephalopathy(HE)and severe HE,and hepatorenal syndrome were assessed as outcomes.LTF survival was estimated using a HR with a95%CI.Other outcomes were estimated using OR with95%CIs.Sensitivity analyses were performed to assess the effects of potential outliers in the studies according to the risk of bias and the study characteristics.RESULTS:Six randomized controlled trials with 390patients were included.In comparison to paracentesis,TIPS significantly improved LTF survival(HR=0.61,95%CI:0.46-0.82,P<0.001).TIPS also significantly decreased liver disease-related death(OR=0.62,95%CI:0.39-0.98,P=0.04),recurrent ascites(OR=0.15,95%CI:0.09-0.24,P<0.001)and hepatorenal syndrome(OR=0.32,95%CI:0.12-0.86,P=0.02).However,TIPS increased the risk of HE(OR=2.95,95%CI:1.87-4.66,P=0.02)and severe HE(OR=2.18,95%CI:1.27-3.76,P=0.005).CONCLUSION:TIPS significantly improved the LTF survival of cirrhotic patients with refractory ascites and decreased the risk of recurrent ascites and hepatorenal syndrome with the cost of increased risk of HE compared with paracentesis.Further studies are warranted to validate the survival benefit of TIPS in clinical practice settings. | Ming Bai Xing-Shun Qi Zhi-Ping Yang Man Yang Dai-Ming Fan Guo-Hong Han | 2014 | World Journal of Gastroenterology2014，20，10： | 29 |
| 2 | Clinical effects and complications of TIPS for portal hypertension due to cirrhosis:A single center显示文摘AIM:To determine the clinical effects and complications of transjugular intrahepatic portosystemic shunt(TIPS)for portal hypertension due to cirrhosis.METHODS:Two hundred and eighty patients with portal hypertension due to cirrhosis who underwent TIPS were retrospectively evaluated.Portal trunk pressure was measured before and after surgery.The changes in hemodynamics and the condition of the stent were assessed by ultrasound and the esophageal and fundic veins observed endoscopically.RESULTS:The success rate of TIPS was 99.3%.The portal trunk pressure was 26.8±3.6 cmH2O after surgery and 46.5±3.4 cmH2O before surgery(P<0.01).The velocity of blood flow in the portal vein increased.The internal diameters of the portal and splenic veins were reduced.The short-term hemostasis rate was100%.Esophageal varices disappeared completely in68%of patients and were obviously reduced in 32%.Varices of the stomach fundus disappeared completely in 80%and were obviously reduced in 20%of patients.Ascites disappeared in 62%,were markedly reduced in 24%,but were still apparent in 14%of patients.The total effective rate of ascites reduction was 86%.Hydrothorax completely disappeared in 100%of patients.The incidence of post-operative stent stenosis was 24%at 12 mo and 34%at 24 mo.The incidence of post-operative hepatic encephalopathy was 12%at3 mo,17%at 6 mo and 19%at 12 mo.The incidence of post-operative recurrent hemorrhage was 9%at 12mo,19%at 24 mo and 35%at 36 mo.The cumulative survival rate was 86%at 12 mo,81%at 24 mo,75%at 36 mo,57%at 48 mo and 45%at 60 mo.CONCLUSION:TIPS can effectively lower portal hypertension due to cirrhosis.It is significantly effective for hemorrhage of the digestive tract due to rupture of esophageal and fundic veins and for ascites and hydrothorax caused by portal hypertension. | Jian-Ping Qin Ming-De Jiang Wen Tang Xiao-Ling Wu Xin Yao Wei-Zheng Zeng Hui Xu Qian-Wen He Ming Gu | 2013 | World Journal of Gastroenterology2013，19，44： | 25 |
| 3 | Transjugular intrahepatic portosystemic shunt for the management of acute variceal hemorrhage显示文摘Acute variceal hemorrhage,a life-threatening condition that requires a multidisciplinary approach for effective therapy,is defined as visible bleeding from an esophageal or gastric varix at the time of endoscopy,the presence of large esophageal varices with recent stigmata of bleeding,or fresh blood visible in the stomach with no other source of bleeding identified.Transfusion of blood products,pharmacological treatments and early endoscopic therapy are often effective;however,if primary hemostasis cannot be obtained or if uncontrollable early rebleeding occurs,transjugular intrahepatic portosystemic shunt(TIPS)is recommended as rescue treatment.The TIPS represents a major advance in the treatment of complications of portal hypertension.Acute variceal hemorrhage that is poorly controlled with endoscopic therapy is generally well controlled with TIPS,which has a 90%to 100%success rate.However,TIPS is associated with a mortality of 30%to 50%in such a setting.Emergency TIPS should be considered early in patients with refractory variceal bleeding once medical treatment and endoscopic sclerotherapy failure,before the clinical condition worsens.Furthermore,admission to specialized centers is mandatory in such a setting and regional protocols are essential to be organized effectively.This review article discusses initial management and then focuses on the specific role of TIPS as a primary therapy to control acute variceal hemorrhage,particularly as a rescue therapy following failure of endoscopic approaches. | Romaric Loffroy Louis Estivalet Violaine Cherblanc Sylvain Favelier Pierre Pottecher Samia Hamza Anne Minello Patrick Hillon Pierre Thouant Pierre-Henri Lefevre Denis Krausé Jean-Pierre Cercueil | 2013 | World Journal of Gastroenterology2013，19，37： | 25 |
| 4 | Shunting branch of portal vein and stent position predict survival after transjugular intrahepatic portosystemic shunt显示文摘AIM:To evaluate the effect of the shunting branch of the portal vein(PV)(left or right)and the initial stent position(optimal or suboptimal)of a transjugular intrahepatic portosystemic shunt(TIPS).METHODS:We retrospectively reviewed 307 consecu5tive cirrhotic patients who underwent TIPS placement for variceal bleeding from March 2001 to July 2010 at our center.The left PV was used in 221 patients and the right PV in the remaining 86 patients.And,224 and83 patients have optimal stent position and sub-optimal stent positions,respectively.The patients were followed until October 2011 or their death.Hepatic encephalopathy,shunt dysfunction,and survival were evaluated as outcomes.The difference between the groups was compared by Kaplan-Meier analysis.A Cox regression model was employed to evaluate the predictors.RESULTS:Among the patients who underwent TIPS to the left PV,the risk of hepatic encephalopathy(P=0.002)and mortality were lower(P<0.001)compared to those to the right PV.Patients who underwent TIPS with optimal initial stent position had a higher primary patency(P<0.001)and better survival(P=0.006)than those with suboptimal initial stent position.The shunting branch of the portal vein and the initial stent position were independent predictors of hepatic encephalopathy and shunt dysfunction after TIPS,respectively.And,both were independent predictors of survival.CONCLUSION:TIPS placed to the left portal vein with optimal stent position may reduce the risk of hepatic encephalopathy and improve the primary patency rates,thereby prolonging survival. | Ming Bai Chuang-Ye He Xing-Shun Qi Zhan-Xin Yin Jian-Hong Wang Wen-Gang Guo Jing Niu Jie-Lai Xia Zhuo-Li Zhang Andrew C Larson Kai-Chun Wu Dai-Ming Fan Guo-Hong Han | 2014 | World Journal of Gastroenterology2014，20，3： | 26 |
| 5 | Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt to reduce hepatic encephalopathy显示文摘BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS) is currently used for the treatment of complications of portal hypertension. The incidence of hepatic encephalopathy(HE) remains a problem in TIPS placement. It has been reported that the right branch mainly receives superior mesenteric venous blood while the left branch mainly receives blood from the splenic vein. We hypothesized that targeted puncture of the left portal vein would divert the non-nutritive blood from the splenic vein into the TIPS shunt; therefore, targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE.AIM To evaluate the influence of targeted puncture of left branch of portal vein in TIPS on HE.METHODS A retrospective analysis of 1244 patients with portal-hypertension-related complications of refractory ascites or variceal bleeding who underwent TIPS from January 2000 to January 2013 was performed. Patients were divided into group A(targeting left branch of portal vein, n = 937) and group B(targeting right branch of portal vein, n = 307). TIPS-related HE and clinical outcomes were analyzed.RESULTS The symptoms of ascites and variceal bleeding disappeared within a short time.By the endpoint of follow-up, recurrent bleeding and ascites did not differ significantly between groups A and B(P = 0.278, P = 0.561, respectively).Incidence of HE differed significantly between groups A and B at 1 mo(14.94% vs36.80%, χ~2 = 4.839, P = 0.028), 3 mo(12.48% vs 34.20%, χ~2 = 5.054, P = 0.025), 6 mo(10.03% vs 32.24%, χ~2 = 6.560, P = 0.010), 9 mo(9.17% vs 31.27%, χ~2 = 5.357, P =0.021), and 12 mo(8.21% vs 28.01, χ~2 = 3.848, P = 0.051). There were no significant differences between groups A and B at 3 years(6.61% vs 7.16%, χ~2 = 1.204, P =0.272) and 5 years(5.01% vs 6.18%, χ~2 = 0.072, P = 0.562). The total survival rate did not differ between groups A and B(χ~2 = 0.226, P = 0.634, log-rank test).CONCLUSION Targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE but has no direct influence on prognosis of portalhypertension-related complications. | Shi-Hua Luo Jian-Guo Chu He Huang Guo-Rui Zhao Ke-Chun Yao | 2019 | World Journal of Gastroenterology2019，25，9： | 22 |
| 6 | Effects of combined splenorenal shunt devascularization and devascularization only on hemodynamics of the portal venous system in patients with portal hypertension显示文摘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. | Department of General Surgery, Renji Hospital, Shanghai 200127, China (Cao H, Hua R and Wu ZY) | 2005 | Hepatobiliary & Pancreatic Diseases International2005，4，3： | 18 |
| 7 | Transjugular Intrahepatic Portosystemic Shunt Versus Surgical Shunting in the Management of Portal Hypertension显示文摘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[C/]: (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. | Long Huang Qing-Sheng Yu Qi Zhang Ju-Da Liu Zhen Wang | 2015 | Chinese Medical Journal2015，，6： | 17 |
| 8 | Surgical treatment of Budd-Chiari syndrome:analysis of 221 cases显示文摘BACKGROUND:Budd-Chiari syndrome (B-CS) refers to post-hepatic portal hypertension and/or inferior vena cava hypertension caused by obstruction of blood flow at the portal cardinal hepatic vein.The treatments of B-CS include operations on pathological membrane lesions,shunting and combined operations.Studies have shown that China,Japan,India and South Africa have a high incidence of B-CS.In China,the Yellow River Basin in Henan,Shandong,Jiangsu and Anhui Provinces also have a high incidence,around 10 per 100 000.METHODS:The clinical data of 221 B-CS patients were analyzed retrospectively.We focused on pathological types,surgical methods,effectiveness and complications of treatment,and follow-up.RESULTS:Based on imaging findings such as color ultrasonography,angiography or magnetic resonance angiography,the 221 patients were divided into 3 types (five subtypes):type Ia (72 patients),type Ib (20),type II (72),type IIIa (33),and type IIIb (24).Surgical procedures included balloon membranotomy with or without stent (65 patients),improved splenopneumopexy (18),radical resection of membrane and thrombus (17),inferior vena cava bypass [29,with cavocaval transflow (13) and cavoatrial transflow (16)],mesocaval shunt (41),splenocaval shunt (25),splenoatrial shunt (12),splenojugular shunt (6),and combined methods (8).The complication rate was 9.05% (20/221) and the perioperative death rate was 2.26% (5/221).All of the patients were followed up from 6 months to 5 years.The success rate was 84.6% (187/221),and the recurrence rate was 8.9% (9/101) and 13.5% (13/96) after 1-and 5-year follow-up,respectively.CONCLUSION:The rational choice of surgical treatment based on B-CS pathological typing may increase the success rate and decrease the recurrence. | Xiao-Wei Dang,Pei-Qin Xu,Xiu-Xian Ma,Da-Qian Xu,Yan-Ju Zhu and Yong-Shuai Zhang Division of Hepatobiliary and Pancreatic Surgery,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China | 2011 | Hepatobiliary & Pancreatic Diseases International2011，10，4： | 17 |
| 9 | contrast enhanced computed tomography and reconstruction of hepatic vascular system for transjugular intrahepatic portal systemic shunt puncture path planning显示文摘AIM: To describe a method for the transjugular intrahepatic portal systemic shunt(TIPS) placement performed with the aid of contrast-enhanced computed tomography(CECT) and three-dimensional reconstructed vascular images(3D RVIs), and to assess its safety and effectiveness. METHODS: Four hundred and ninety patients were treated with TIPS between January 2005 and December 2012. All patients underwent liver CECT and reconstruction of 3D RVIs of the right hepatic vein to portal vein(PV) prior to the operation. The 3D RVIs were carefully reviewed to plan the puncture path fromthe start to target points for needle pass through the PV in the TIPS procedure. R E S U LTS :The improved TIPS procedure was successful in 483(98.6%) of the 490 patients. The number of punctures attempted was one in 294(60%) patients, 2 to 3 in 147(30%) patients, 4 to 6 in 25(5.1%) patients and more than 6 in 17(3.5%) patients. Seven patients failed. Of the 490 patients, 12 had punctures into the artery, 15 into the bile duct, eight into the gallbladder, and 18 through the liver capsule. Analysis of the portograms from the 483 successful cases indicated that the puncture points were all located distally to the PV bifurcation on anteroposterior images, while the points were located proximally to the bifurcation in the three cases with intraabdominal bleeding. The complications included three cases of bleeding, of whom one died and two needed surgery. CONCLUSION: Use of CECT and 3D RVIs to plan the puncture path for TIPS procedure is safe, simple and effective for clinical use. | Jian-Ping Qin Shan-Hong Tang Ming-De Jiang Qian-Wen He Hong-Bin Chen Xin Yao Wei-Zheng Zeng Ming Gu | 2015 | World Journal of Gastroenterology2015，21，32： | 17 |
| 10 | Combined transjugular intrahepatic portosystemic shunt and other interventions for hepatocellular carcinoma with portal hypertension显示文摘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. | Bin Qiu Meng-Fei Zhao Zhen-Dong Yue Hong-Wei Zhao Lei Wang Zhen-Hua Fan Fu-Liang He Shan Dai Jian-Nan Yao Fu-Quan Liu | 2015 | World Journal of Gastroenterology2015，21，43： | 16 |
| 11 | Two surgical procedures for esophagogastric variceal bleeding in patients with portal hypertension显示文摘AIM:To determine the clinical value of a splenorenal shunt plus pericardial devascularization(PCVD)in portal hypertension(PHT)patients with variceal bleeding.METHODS:From January 2008 to November 2012,290 patients with cirrhotic portal hypertension were treated surgically in our department for the prevention of gastroesophageal variceal bleeding:207 patients received a routine PCVD procedure(PCVD group),and83 patients received a PCVD plus a splenorenal shunt procedure(combined group).Changes in hemodynamic parameters,rebleeding,encephalopathy,portal vein thrombosis,and mortality were analyzed.RESULTS:The free portal pressure decreased to 21.43±4.35 mmHg in the combined group compared with24.61±5.42 mmHg in the PCVD group(P<0.05).The changes in hemodynamic parameters were more significant in the combined group(P<0.05).The long-term rebleeding rate was 7.22%in the combined group,which was lower than that in the PCVD group(14.93%),(P<0.05).CONCLUSION:Devascularization plus splenorenal shunt is an effective and safe strategy to control esophagogastric variceal bleeding in PHT.It should be recommended as a first-line treatment for preventing bleeding in PHT patients when surgical interventions are considered. | Lin Yang Li-Juan Yuan Rui Dong Ji-Kai Yin Qing Wang Tao Li Jiang-Bin Li Xi-Lin Du Jian-Guo Lu | 2013 | World Journal of Gastroenterology2013，19，48： | 15 |
| 12 | Small for size syndrome following living donor and split liver transplantation显示文摘The field of liver transplantation is limited by the availability of donor organs. The use of living donor and split cadaveric grafts is one potential method of expanding the donor pool. However, primary graft dysfunction can result from the use of partial livers despite the absence of other causes such as vascular obstruction or sepsis. This increasingly recognised phenomenon is termed 'Small-for-size syndrome' (SFSS). Studies in animal models and humans have suggested portal hyperperfusion of the graft combined with poor venous outflow and reduced arterial flow might cause sinusoidal congestion and endothelial dysfunction. Graft related factors such as graft to recipient body weight ratio < 0.8, impaired venous outflow, steatosis > 30% and pro- longed warm/cold ischemia time are positively predictive of SFSS. Donor related factors include deranged liver function tests and prolonged intensive care unit stay greater than five days. Child-Pugh grade C recipients are at relatively greater risk of developing SFSS. Surgi- cal approaches to prevent SFSS fall into two categories: those targeting portal hyperperfusion by reducing inflow to the graft, including splenic artery modulation and portacaval shunts; and those aiming to relieve paren-chymal congestion. This review aims to examine thecontroversial diagnosis of SFSS, including current strate-gies to predict and prevent its occurrence. We will also consider whether such interventions could jeopardize the graft by compromising regeneration. | Hector Daniel Gonzalez Sophia Cashman Giuseppe K Fusai | 2010 | World Journal of Gastrointestinal Surgery2010，2，12： | 13 |
| 13 | Predictors of mortality after transjugular portosystemic shunt显示文摘AIM:To investigate if echocardiographic and hemodynamic determinations obtained at the time of transjugular intrahepatic portosystemic shunt(TIPS)can provide prognostic information that will enhance risk stratification of patients.METHODS:We reviewed medical records of 467 patients who underwent TIPS between July 2003 and December 2011 at our institution.We recorded information regarding patient demographics,underlying liver disease,indication for TIPS,baseline laboratory values,hemodynamic determinations at the time of TIPS,and echocardiographic measurements both before and after TIPS.We recorded patient comorbidities that may affect hemodynamic and echocardiographic determinations.We also calculated Model for Endstage Liver Disease(MELD)score and Child Turcotte Pugh(CTP)class.The following pre-and post-TIPS echocardiographic determinations were recorded:Left ventricular ejection fraction,right ventricular(RV)systolic pressure,subjective RV dilation,and subjective RV function.We recorded the following hemodynamic measurements:Right atrial(RA)pressure before and after TIPS,inferior vena cava pressure before and after TIPS,free hepatic vein pressure,portal vein pressure before and after TIPS,and hepatic venous pressure gradient(HVPG).RESULTS:We reviewed 418 patients with portal hypertension undergoing TIPS.RA pressure increased by a mean ± SD of 4.8 ± 3.9 mmH g(P < 0.001),HVPG decreased by 6.8 ± 3.5 mmH g(P < 0.001).In multivariate linear regression analysis,a higher MELD score,lower platelet count,splenectomy and a higher portal vein pressure were independent predictors of higher RA pressure(R = 0.55).Three variables predicted 3-mo mortality after TIPS in a multivariate analysis:Age,MELD score,and CTP grade C.Change in the RA pressure after TIPS predicted long-term mortality(per 1 mm Hg change,HR = 1.03,95%CI:1.01-1.06,P < 0.012).CONCLUSION:RA pressure increased immediately after TIPS particularly in patients with worse liver function,portal hypertension,emergent TIPS placement and history of splenectomy.The increase in RA pressure after TIPS was associated with increased mortality.Age,splenectomy,MELD score and CTP grade were independent predictors of long-term mortality after TIPS. | Mona Ascha Sami Abuqayyas Ibrahim Hanouneh Laith Alkukhun Mark Sands Raed A Dweik Adriano R Tonelli | 2016 | World Journal of Hepatology2016，8，11： | 13 |
| 14 | Selection of a TIPS stent for management of portal hypertension in liver cirrhosis: An evidence-based review显示文摘Nowadays,transjugular intrahepatic portosystemic shunt(TIPS)has become a mainstay treatment option for the management of portal hypertension-related complications in liver cirrhosis.Accumulated evidence has shown that its indications are being gradually expanded.Notwithstanding,less attention has been paid for the selection of an appropriate stent during a TIPS procedure.Herein,we attempt to review the current evidence regarding the diameter,type,brand,and position of TIPS stents.Several following recommendations may be considered in the clinical practice:(1)a 10-mm stent may be more effective than an 8-mm stent for the management of portal hypertension,and may be superior to a 12-mm stent for the improvement of survival and shunt patency;(2)covered stents are superior to bare stents for reducing the development of shunt dysfunction;(3)if available,Viatorr stent-grafts may be recommended due to a higher rate of shunt patency;and(4)the placement of a TIPS stent in the left portal vein branch may be more reasonable for decreasingthe development of hepatic encephalopathy.However,given relatively low quality of evidence,prospective well-designed studies should be warranted to further confirm these recommendations. | Xing-Shun Qi Ming Bai Zhi-Ping Yang Dai-Ming Fan | 2014 | World Journal of Gastroenterology2014，20，21： | 13 |
| 15 | 心理护理在经颈静脉肝内门体静脉分流术中的价值显示文摘食管胃底静脉曲张破裂出血是肝硬化患者最严重的并发症之一,目前药物治疗效果欠佳,而经颈静脉肝内门体静脉分流术(transjugular intrahepatic portal systemic shunt,TIPS)对该疾病具有较好的疗效,呈现逐渐取代外科手术的趋势[1]。然而TIPS具有技术难度大、手术风险高、术中及术后并发症较多等特点,因此对护理的要求也较高[2-3]。 | 谢春花 呼增吉 蔡笃雄 李慧子 李小珍 | 2017 | 重庆医学2017，46，21： | 12 |
| 16 | Transjugular intrahepatic portosystemic shunt with covered stents for hepatocellular carcinoma with portal vein tumor thrombosis显示文摘AIM: To evaluate transjugular intrahepatic portosystemic shunt(TIPS) with covered stents for hepatocellular carcinoma(HCC) with main portal vein tumor thrombus(PVTT). METHODS: Eleven advanced HCC patients(all male, aged 37-78 years, mean: 54.3 ± 12.7 years) presented with acute massive upper gastrointestinal bleeding(n = 9) or refractory ascites(n = 2) due to tumor thrombus in the main portal vein. The diagnosis of PVTT was based on contrast-enhanced computed tomography and color Doppler sonography. The patients underwent TIPS with covered stents. Clinical characteristics and average survival time of 11 patients were analyzed. Portal vein pressure was assessed before and after TIPS. The follow-up period was 2-18 mo. RESULTS: TIPS with covered stents was successfully completed in all 11 patients. The mean portal vein pressure was reduced from 32.0 to 11.8 mmHg(t = 10.756, P = 0.000). Gastrointestinal bleeding was stopped in nine patients. Refractory ascites completely disappeared in one patient and was alleviated in another. Hepatic encephalopathy was observed in six patients and was resolved with drug therapy. During the follow-up, ultrasound indicated the patency of the shunt and there was no recurrence of symptoms. Death occurred 2-14 mo(mean: 5.67 mo) after TIPS in nine cases, which were all due to multiple organ failure. In the remaining two cases, the patients were still alive at the 16- and 18-mo follow-up, respectively. CONCLUSION: TIPS with covered stents for HCC patients with tumor thrombus in the main portal vein is technically feasible, and short-term efficacy is favorable. | Jian-Bo Zhao Chao Feng Qiao-Hua Zhu Xiao-Feng He Yan-Hao Li Yong Chen | 2014 | World Journal of Gastroenterology2014，20，6： | 12 |
| 17 | Spontaneous porto-systemic shunts in liver cirrhosis:Clinical and therapeutical aspects显示文摘Spontaneous porto-systemic shunts(SPSS)are frequent in liver cirrhosis and their prevalence increases as liver function deteriorates,probably as a consequence of worsening portal hypertension,but without achieving an effective protection against cirrhosis'complications.Several types of SPSS have been described in the literature,each one associated with different clinical manifestations.In particular,recurrent or persistent hepatic encephalopathy is more frequent in patients with splenorenal shunt,while the presence of gastric varices and consequently the incidence of variceal bleeding is more common in gastrorenal shunt.In the advanced stage,the presence of large SPSS can lead to the so called“portosystemic shunt syndrome”,characterized by a progressive deterioration of hepatic function,hepatic encephalopathy and,sometimes,portal vein thrombosis.The detection of SPSS in patients with liver cirrhosis is recommended in order to prevent or treat recurrent hepatic encephalopathy or variceal bleeding. | Silvia Nardelli Oliviero Riggio Stefania Gioia Marta Puzzono Giuseppe Pelle Lorenzo Ridola | 2020 | World Journal of Gastroenterology2020，26，15： | 11 |
| 18 | Imaging and interventions in Budd-Chiari syndrome显示文摘Budd-Chiari syndrome(BCS) consists of a group of disorders with obstruction of hepatic venous outflow leading to increased hepatic sinusoidal pressure and portal hypertension.Clinically,two forms of disease(acute and chronic) are recognized.Mostly the patients present with ascites,hepatomegaly,and portal hypertension.In acute disease the liver is enlarged with thrombosed hepatic veins(HV) and ascites,whereas in the chronic form of the disease there may be membranous occlusion of HV and/or the inferior vena cava(IVC),or there may be short or long segment fibrotic constriction of HV or the suprahepatic IVC.Due to advances in radiological interventional techniques and hardware,there have been changes in the management protocol of BCS with surgery being offered to patients not suitable for radiological interventions or having acute liver failure requiring liver transplantation.The present article gives an insight into various imaging findings and interventional techniques employed in the management of BCS. | Amar Mukund Shivanand Gamanagatti | 2011 | World Journal of Radiology2011，3，7： | 11 |
| 19 | Transjugular intrahepatic portosystemic shunt for the prevention of recurrent esophageal variceal bleeding in patients with cavernous transformation of portal vein显示文摘Background: Treatment options for patients with cavernous transformation of portal vein(CTPV) are limited. This study aimed to evaluate the feasibility, efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS) to prevent recurrent esophageal variceal bleeding in patients with CTPV. Methods: We retrospectively analyzed 67 consecutive patients undergone TIPS from January 2011 to December 2016. All patients were diagnosed with CTPV. The indication for TIPS was a previous episode of variceal bleeding. The data on recurrent bleeding, stent patency, hepatic encephalopathy and survival were retrieved and analyzed. Results: TIPS procedure was successfully performed in 56 out of 67(83.6%) patients with CTPV. TIPS was performed via a transjugular approach alone( n = 15), a combined transjugular/transhepatic approach( n = 33) and a combined transjugular/transsplenic approach( n = 8). Mean portosystemic pressure gradient(PSG) decreased from 28.09 ± 7.28 mmHg to 17.53 ± 6.12 mmHg after TIPS( P < 0.01). The probability of the remaining free recurrent variceal bleeding was 87.0%. The probability of TIPS patency reached 81.5%. Hepatic encephalopathy occurrence was 27.8%, and survival rate was 88.9% until the end of follow-up. Four out of 11 patients who failed TIPS died, and 4 had recurrent bleeding. Conclusions: TIPS should be considered a safe and feasible alternative therapy to prevent recurrent esophageal variceal bleeding in patients with CTPV, and to achieve clinical improvement. | Zhao-Peng Li Sui-Sui Wang Guang-Chuan Wang Guang-Jun Huang Jing-Qin Cao Chun-Qing Zhang | 2018 | Hepatobiliary & Pancreatic Diseases International2018，17，6： | 11 |
| 20 | Safety and efficacy of transjugular intrahepatic portosystemic shunt combined with palliative treatment in patients with hepatocellular carcinoma显示文摘BACKGROUND There is a close relationship between cirrhosis and hepatocellular carcinoma (HCC). Transjugular intrahepatic portosystemic shunt (TIPS) has good clinical effect in treating the complication of portal hypertension. However, because of the risk of postoperative liver failure, severe complications, and low survival rate for HCC, TIPS is contraindicated in patients with portal hypertension and liver cancer. We studied a large cohort of patients with cirrhosis and HCC who underwent TIPS for recurrent variceal bleeding and/or ascites. AIM To assess the safety, efficacy, and survival rate in patients with HCC who underwent TIPS. METHODS Group A comprised 217 patients with HCC and portal hypertension who underwent the TIPS procedure between 1999 and 2014. After TIPS deployment, these patients received palliative treatment for HCC. Group B comprised a cohort of 136 HCC patients with portal hypertension who did not undergo TIPS placement. Group B received palliative treatment for HCC plus medical therapy for portal hypertension. The clinical outcomes and survival rate were assessed. RESULTS In Group A, the primary technical success rate was 97.69% for TIPS placement,and no severe procedure-related complications of TIPS placement were reported. The control of variceal bleeding (VB) within 1 mo did not differ significantly between the groups (P = 0.261). Absorption of refractory ascites within 1 mo, recurrence of VB, and recurrence of refractory ascites differed significantly between the groups (P = 0.017, 0.023, and 0.009, respectively). By comparison, the rate of hepatic encephalopathy in Group B was lower than that in Group A (P = 0.036). The 1-, 2-, 3-, 4-, and 5-year survival rates were significantly different between Groups A and B (χ^2 = 12.227, P = 0.018;χ^2 = 12.457, P = 0.014;χ^2 = 26.490, P = 0.013;χ^2 = 21.956, P = 0.009, and χ^2 = 24.596, P = 0.006, respectively). The mean survival time was 43.7 mo in Group A and 31.8 mo in Group B. Median survival time was 50.0 mo in Group A and 33.0 mo in Group B. Mean and median survival differed significantly between the two groups (P = 0.000,χ^2 = 35.605, log-rank test). The mortality rate from VB in Group A was higher than that in Group B (P = 0.006), but the rates of hepatic tumor, hepatic failure, and multiorgan failure did not differ significantly between the two groups (P = 0.173, 0.246 and 0.257, respectively). CONCLUSION TIPS combined with palliative treatment is safe and effective for portal hypertension in patients with HCC. | Shi-Hua Luo Jian-Guo Chu He Huang Ke-Chun Yao | 2019 | World Journal of Clinical Cases2019，7，13： | 10 |
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