Long-term Prognostic Evaluation of Transjugular Intrahepatic Portosystemic Shunt

概要

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To assess the long term prognosis of transjugular intrahepatic portosystemic shunt (TIPS), a total of 28 patients with portal hypertension who had been treated with TIPS were studied. Of these, 16 patients underwent TIPS for esophago-gastric varices, 10 for refractory ascites and two for portal hypertensive gastropathy. Six of these patients were complicated with hepatocellular carcinoma. Child-Pugh score of 26 patients who survived 1 year or longer after TIPS was 8.4 before TIPS, 8.0 at 4 weeks and 8.8 at 1 year. Score of ascites was significantly improved after TIPS. A shunt occlusion rate was as high as 60.7%. However, shunt obstruction was accessible for a second intervention. Overall patency was 96% at 1 year, 96% at 2 years and 87% at 3 years. One patient had rebleeding of varices after TIPS. Survival rates were 92% at 1 year, 40% at 3 years and 30% at 5 years. A mean survival period was 27 months. Overall, 15 patients died : 6 patients died of hepatic failure and 4 patients died of hepatocellular carcinoma. Because Child-Pugh score showed no significant change before and after the procedure, TIPS appears to be safe and effective for portal hypertension which is difficult to be controlled by other treatments.
The Japan Society for Portal Hypertensionの論文