BACKGROUNDMain portal vein tumor thrombus (MPVTT), which has a high incidence, is the major complication of terminal liver cancer.The occurrence of MPVTT is always a negative prognostic factor for patients with hepatocellular carcinoma (HCC).Therefore, attention should be paid to the treatment of MPVTT and its complications. AIMTo evaluate the efficacy of transarterial chemoembolization/transarterial embolization (TACE/TAE)+ 125 I seeds implantation with transjugular intrahepatic portosystemic shunt (TIPS) in treating MPVTT and its complications. METHODSFrom January 2007 to March 2015, 85 consecutive patients with MPVTT were nonrandomly assigned to undergo treatment with TACE/TAE + TIPS and 125 I implantation (TIPS-125 I group) or TACE/TAE + TIPS only (TIPS only group) in Beijing Shijitan Hospital, and all clinical data were collected.During 24 mo follow-up, the incidence of overall survival, stent stenosis and symptom recurrence was analyzed to evaluate the efficacy of TIPS-125 I.
Abstract Background: The hemodynamics of patients with cirrhosis and portal hypertension are complex and variable. We aimed to investigate differences in venous pressures determined by innovative angiography and conventional angiography using balloon occlusion of the hepatic veins in patients with alcoholic cirrhosis and portal hypertension. Methods: A total of 134 patients with alcoholic cirrhosis who fulfilled the inclusion criteria from June 2017 to June 2020 were included. During transjugular intrahepatic portosystemic shunt, conventional and innovative angiography were performed, and venous pressures were measured. A paired t -test and Pearson’s correlation coefficient were used for analysis. Results: Conventional and innovative hepatic angiography detected lateral branches of the hepatic vein in 26 (19.4 %) and 65 (48.5 %) cases, respectively ( P <0.001). Innovative angiography detected a total of 65 patients with lateral shunts, of whom 37 (56.9%) had initial shunts. The average wedged hepatic venous pressure and portal venous pressure of the initial lateral branches were 21.27±6.66 and 35.84±7.86 mmHg, respectively, with correlation and determination coefficients of 0.342 ( P <0.05) and 0.117, respectively. The mean hepatic venous pressure gradient and portal pressure gradient were 9.59±7.64 and 26.86±6.78 mmHg, respectively, with correlation and determination coefficients of 0.292 ( P =0.079) and 0.085, respectively. Conclusions: Innovative angiography reveals collateral branches of the hepatic veins more effectively than conventional angiography. Hepatic vein collateral branches are the primary factors leading to underestimation of wedged hepatic venous pressures and hepatic venous pressure gradients, with the initial hepatic vein collateral branches resulting in the most severe underestimations.
Background. Transjugular intrahepatic portosystemic shunt (TIPS) is an artificial channel from the portal vein to the hepatic vein or vena cava for controlling portal vein hypertension. The major drawbacks of TIPS are shunt stenosis and hepatic encephalopathy (HE); previous studies showed that post-TIPS shunt stenosis and HE might be correlated with the pathological features of the liver tissues. Therefore, we analyzed the pathological predictors for clinical outcome, to determine the risk factors for shunt stenosis and HE after TIPS. Methods. We recruited 361 patients who suffered from portal hypertension symptoms and were treated with TIPS from January 2009 to December 2012. Results. Multivariate logistic regression analysis showed that the risk of shunt stenosis was increased with more severe inflammation in the liver tissue (OR, 2.864; 95% CI: 1.466-5.592; P = 0.002), HE comorbidity (OR, 6.266; 95% CI, 3.141-12.501; P < 0.001), or higher MELD score (95% CI, 1.298-1.731; P < 0.001). Higher risk of HE was associated with shunt stenosis comorbidity (OR, 6.266; 95% CI, 3.141-12.501; P < 0.001), higher stage of the liver fibrosis (OR, 2.431; 95% CI, 1.355-4.359; P = 0.003), and higher MELD score (95% CI, 1.711-2.406; P < 0.001). Conclusion. The pathological features can predict individual susceptibility to shunt stenosis and HE.
Hepatic venous pressure gradient (HVPG) is the gold standard for diagnosis of portal hypertension (PH), invasiveness and potential risks in the process of measurement limited its widespread use.To investigate the correlation of computed tomography (CT) perfusion parameters with HVPG in PH, and quantitatively assess the blood supply changes in liver and spleen parenchyma before and after transjugular intrahepatic portosystemic shunt (TIPS).Twenty-four PH related gastrointestinal bleeding patients were recruited in this study, and all patients were performed perfusion CT before and after TIPS surgery within 2 wk. Quantitative parameters of CT perfusion, including liver blood volume (LBV), liver blood flow (LBF), hepatic arterial fraction (HAF), spleen blood volume (SBV) and spleen blood flow (SBF), were measured and compared before and after TIPS, and the quantitative parameters between clinically significant PH (CSPH) and non-CSPH (NCSPH) group were also compared. Then the correlation of CT perfusion parameters with HVPG were analyzed, with statistical significance as P < 0.05.For all 24 PH patients after TIPS, CT perfusion parameters demonstrated decreased LBV, increased HAF, SBV and SBF, with no statistical difference in LBF. Compared with NCSPH, CSPH showed higher HAF, with no difference in other CT perfusion parameters. HAF before TIPS showed positive correlation with HVPG (r = 0.530, P = 0.008), while no correlation was found in other CT perfusion parameters with HVPG and Child-Pugh scores.HAF, an index of CT perfusion, was positive correlation with HVPG, and higher in CSPH than NCSPH before TIPS. While increased HAF, SBF and SBV, and decreased LBV, were found after TIPS, which accommodates a potential non-invasive imaging tool for evaluation of PH.
Transfemoral intrahepatic portosystemic shunt (TFIPS) can be performed to treat portal hypertension. However, few studies have evaluated the safety and efficacy of this technique.To retrospectively evaluate the safety and clinical outcomes of TFIPS and compare them with those of typical transjugular intrahepatic portosystemic shunt (TIPS).This retrospective study was approved by our hospital ethics committee. From November 2012 to November 2015, 19 patients who underwent successful TFIPS placement were included. In addition, 21 patients treated with TIPS during the same period were selected as controls. Data collected included the success rate and complications of TIPS and TFIPS. Continuous data were expressed as the mean ± SD and were compared using the Student's t test. All categorical data were expressed as count (percentage) and were compared using the χ2 test or Fisher's exact test. The Kaplan-Meier method was used to calculate cumulative survival rate and survival curves.Baseline characteristics were comparable between the two groups. The success rate of TFIPS and TIPS was 95% (19/20) and 100% (21/21), respectively. Effective portal decompression and free antegrade shunt flow was completed in all patients. The portal pressure gradient prior to TIPS and TFIPS placement was 23.91 ± 4.64 mmHg and 22.61 ± 5.39 mmHg, respectively, and it was significantly decreased to 10.85 ± 3.33 mmHg and 10.84 ± 3.33 mmHg after stent placement, respectively. Time-to-event calculated rates of shunt patency at one and two years in the TFIPS and TIPS groups were not statistically different (94.7% vs 95.2% and 94.7% vs 90.5%, respectively). De nova hepatic encephalopathy was 27.5% (11/40) with five patients in the TFIPS group (26.3%) and six patients (28.6%) in the TIPS group experiencing it (P = 0.873). The cumulative survival rates were similar between the two groups: 94.7% and 94.7% at 1 and 2 years, respectively, in the TFIPS group vs 100% and 95.2% at 1 and 2 years, respectively, in the TIPS group (P = 0.942).TFIPS may be a valuable adjunct to traditional approaches in patients with portal hypertension.
Abstract Background The aim of the present study was to investigate whether portal level of high‐mobility group protein B1 (HMGB1) is associated with hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS). Methods We enrolled 127 consecutive patients who underwent TIPS and collected portal and peripheral blood samples in our department from December 2017 to May 2019. HMGB1 levels were determined using enzyme‐linked immunosorbent assay kits. HMGB1 and other HE related parameters were estimated by competing risk analysis, receiver operating characteristic (ROC) analysis and Kaplan–Meier analysis. Results Patients with HE after TIPS were older ( P = .019) and had higher portal HMGB1 level ( P = .038) than those without. Univariate competing risk analysis: age (sHR 1.025, P = .026), hepatorenal syndrome (sHR 3.149, P = .010), model for end‐of‐stage liver disease (MELD) score (sHR 1.055, P = .024), prior HE (sHR 4.029, P = .0005), portal HMGB1 before TIPS (sHR 1.177, P = .001) reached statistical significance. Multivariate analysis: age (sHR 1.025, P = .037), MELD score (sHR 1.062, P = .011), prior HE (sHR 2.492, P = .030) and portal HMGB1 level before TIPS (sHR 1.217, P = .0002) were significantly different. ROC analyses and Kaplan–Meier curve showed portal HMGB1 level changes before and after TIPS (ΔHMGB1) had good predictive value in the cut‐off 0.012 ng/mL (AUC = 0.748, P < .001, Sensitivity = 0.743, Specificity = 0.655). Conclusions Portal HMGB1 may be a therapeutic target for post‐TIPS HE.
Abstract Either acute or sub-acute Budd–Chiari syndrome (BCS) with diffuse occlusion of hepatic veins has a high mortality rate and remains challenging for clinical treatment. We aimed to evaluate the feasibility and safety of transjugular intrahepatic portosystemic shunt (TIPS) as a treatment for BCS with diffuse occlusion of hepatic veins. From January 2007 to December 2010, 100 patients were randomly recruited onto this study and 91 patients were treated with TIPS. 14 patients were defined as acute BCS group and 86 patients as sub-acute group. Patients with acute BCS had a significantly higher rate of jaundice whereas a lower rate of abdominal and chest varices, gastroesophageal variceal bleeding and refractory ascites than sub-acute group (P < 0.001). TIPS was technically successful in all 91 patients (12 in acute group). The portosystemic pressure gradient (PSG) was decreased to normal level, while total bilirubin (TBIL) and liver function were significantly improved. During follow-up period, the mortality rate of 91 patients who underwent TIPS was 6.59% (6/91), whereas 88.89% of 9 patients who didn’t receive TIPS procedure (2 in acute group). Collectively, TIPS is an effective and safe approach in treating BCS with diffuse occlusion of hepatic veins, which should be performed in time.
Objective
To observe the clinical efficacy and safety of Reduning injection combined with piperacillin sulbactam in the treatment of community acquired pneumonia(CAP).
Methods
122 cases with CAP were randomly divided into treatment group and control group by digital table method.The two groups were given piperacillin sodium and sulbactam sodium 3.75g, once every 12 hours, course 7-10d.The treatment group was treated with Reduning injection, 20ml/d treatment for 7-10d.The clinical symptoms of the two groups before and after treatment, the total number of white blood cells(WBC) and C reactive protein(CRP) to resume normal time were observed.
Results
The effective rate was 94.91% in the treatment group and 80% in the control group, the difference between the two groups was statistically significant(χ2=10.286, P<0.05). The treatment group was significantly shorter than the control group in controlling fever and cough symptoms(all P<0.05).3 months after treatment, the WBC and CRP recovery to the normal rate of the two groups had statistically significant differences (χ2=2.880, 3.926, all P<0.05). No obvious toxic side effects and adverse reactions were observed in the two groups.
Conclusion
Reduning injection combined with piperacillin sodium and sulbactam sodium in the treatment of CAP can alleviate the clinical symptoms of fever.This method has good clinical curative effect and high safety.It can be used as an effective method for treatment of CAP.
Key words:
Pneumonia; Community-acquired infections; Reduning injection; Piperacillin sodium and sulbactam sodium
Objective To assess the relationship between the hepatic vein Lipiodol tram-track sign during transcatheter arterial chemoembolization (TACE) and perioperative death. Methods Patients treated for hepatic carcinoma at the Beijing Shijitan Hospital, Capital Medical University from January 2010 to December 2015 were retrospectively evaluated. The patients underwent hepatic TACE with Lipiodol. The incidence of the hepatic vein Lipiodol tram-track sign, prognosis, and possible risk factors were analyzed. Results A total of 5372 patients underwent hepatic TACE and had complete available intraoperative imaging data. Among them, nine patients showed the hepatic vein Lipiodol tram-track sign, including five who died intraoperatively. The patients who died had liver metastasis from hepatocellular carcinoma, cholangiocarcinoma, or breast cancer and had previously received doxorubicin. The survivors had metastasis from gastric or colorectal cancer and had not received doxorubicin. Conclusion Occurrence of the hepatic vein Lipiodol tram-track sign during hepatic TACE is likely to result in perioperative death.
Objective
To investigate the clinical efficacy of applicating TIPS treatment of cirrhosis and portal hypertension caused refractory pleural effusion and ascites.
Methods
In the retrospective study, 427 consecutive patients with cirrhosis and portal hypertension caused refractory pleural effusion and ascites who have received TIPS treatment were followed-up and analyzed.
Results
The success rate of TIPS were 99.30% (427/430) and there were 85.25% (364/427) patients whose symptoms of pleural effusion and ascites were completely disappeared post-TIPS, besides 8.43% (36/427) were effective and 6.32% (27/427) were ineffective; Cumulative rate of shunt dysfunction post-TIPS were 3.98% (17/427), 18.49% (76/411), 27.39% (103/376), 37.43% (125/334), 46.01% (121/263) and 58.54% (120/205) respectively in 6 months, 1 year, 2 years, 3 years, 4 years and 5 years; The survival rate were 99.53% (425/427), 96.59% (397/411), 87.23% (328/376), 81.14% (271/334), 73.38% (193/263), 57.56% (118/205) respectively in 6 months, 1 year, 2 years, 3 years, 4 years and 5 years. No deaths associated with TIPS-operation in the study.
Conclusions
TIPS should be considered a safe, effective and conventional therapy for cirrhosis and portal hypertension caused refractory pleural effusion and ascites of such disorders, worthy of promotion.
Key words:
Liver cirrhosis; Transjugular intrahepatic portosystemic shunt; Ascites; Efficacy
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