EMERGENCY TRANSJUGULAR INTRAHEPATIC PORTASYSTEMIC STENT SHUNTING AS SALVAGE TREATMENT FOR UNCONTROLLED VARICEAL BLEEDING

被引:96
作者
MCCORMICK, PA
DICK, R
PANAGOU, EB
CHIN, JKT
GREENSLADE, L
MCINTYRE, N
BURROUGHS, AK
机构
[1] UNIV LONDON,ROYAL FREE HOSP,DEPT MED,LONDON,ENGLAND
[2] ROYAL FREE HOSP,DEPT RADIOL,LONDON,ENGLAND
关键词
D O I
10.1002/bjs.1800810922
中图分类号
R61 [外科手术学];
学科分类号
摘要
Creation of a transjugular intrahepatic portasystemic stent shunt (TIPSS) was used as a rescue treatment for patients with variceal bleeding refractory to standard medical and endoscopic treatment. Over a 2-year period 242 episodes of variceal bleeding were treated and emergency shunting was performed on 20 patients with uncontrolled bleeding (Pugh grade A, one; B, seven; C, 12). The procedure was technically successful and controlled bleeding in all patients. Six patients had early rebleeding within 5 days, and further shunting was required in two. Two had late rebleeding related to shunt occlusion and had a further TIPSS procedure followed by portacaval shunting. Twelve patients died within 40 days from liver failure and sepsis, and there were two late deaths after 2 and 6 months, unrelated to bleeding. TIPSS insertion is an effective therapeutic option in patients with acute variceal bleeding refractory to medical and endoscopic treatment. However, despite control of bleeding in this group, the hospital mortality rate was high, reflecting the severity of the underlying liver disease.
引用
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页码:1324 / 1327
页数:4
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