Avtor/Urednik		Popovič, Peter; Šurlan, Miloš
Naslov		Transjugularni intrahepatični portosistemski odvod (TIPS)
Prevedeni naslov		Transjugular intrahepatic portosystemic shunts (TIPS)
Tip		članek
Vir		Gastroenterolog
Vol. in št.		Letnik 8, št. 1-2
Leto izdaje		2004
Obseg		str. 59-66
Jezik		slo
Abstrakt		Background. A clear presentation of TIPS indications and contraindications, which can be divided into absolute and relative, is given. Absolute indications are fresh and renewed bleeding of varices and inveterate asites. Relative indications, on the other hand, are splenomegaly with hypersplenism, Budd-Chiari syndrome, liver transplantation and hepatorenal syndrome. Absolute contraindications are severe liver dysfunction and right heart failure, while the relative ones are polycystic liver degeneration, neoplasm, obstruction of the portal vein and severe local and systemic infection. Before the TIPS procedure, the level of dysfunction of the liver, right heart and kidney is determined. Biochemical and blood test, including a blood coagulation test, are made, the ammonia level in the serum is determined and possible obstructions/strictures of the portal vein are checked. A detailed description of the procedure, a care for patients and a postoperative monitoring are given. The success rate of the procedure is between 93% and 100% and the mortality rate within 30 days becouse TIPS is between 1% and 3%. There are relatively few complications during the procedure. Postoperative complications are more frequent due to the stricture and obstruction of the shunt. Thus, in a group of 50 patients, who were tre ated in the period of six years a TIPS was succesfully placed in 48 patients (96,7%). The total number of rebleeding episodes was 3 (6,25%). A total of 9 shunt malfunctions were detected. 7 cases undervent successful shunt revision, in two case the reintervention was unsuccesfull. Primary, primary-assisted patency was 85,6%, 95,2% at 1 year and 67,4%, 87,3% at 4 years.The cumulative survival was 83%, 79,9%, 79,9% and 73,5% at 1-,2-,3-, and 4 years (Kaplan-Meier). The causes of death were progressive liver failure in 6 patients, variceal bleeding in two patients (both had shunt malfunction) and other causes in 5 patients. (Abstract truncated at 2000 characters).
Izvleček		Izhodišča. V preglednem prispevku avtorja prikazujeta indikacije in kontraindikacije za TIPS, ki jih delimo na absolutne in relativne. Absolutne indikacije so sveža in ponovna krvavitev iz varic in trdovratni ascites. Relativne so splenomegalija s hipersplenizmom, Budd-Chiari sindrom, pred transplantacijo jeter in hepatorenalni sindrom. Absolutni kontraindikaciji sta huda okvara jeter in odpoved desnega srca, relativne pa so policistična degeneracija jeter, neoplazma, zapora portalne vene in hujša lokalna ali sistemska infekcija. Pred posegom določimo stopnjo okvare jeter, desnega srca in ledvic, naredimo biokemične in krvne preiskave s testi koagulacije ter določimo višino amoniaka v serumu in preverimo prehodnost portalne vene. Natančno je opisana izvedba posega, skrb za bolnika in njegovo spremljanje po posegu. Izvedba posega je uspešna v 93-100%, smrtnost znotraj 30. dni zaradi TIPS-a je 1-3%. Zapletov ob posegu je relativno malo, več jih je kasneje zaradi zožitev in zapor šanta. V naši skupini 50 bolnikov, zdravljenih v obdobju šestih let zaradi ponavljajočih kravitev iz varic, smo pri 48. (96,7%) uspešno vstavili TIPS. Moteno prehodnost odvoda smo opazovali pri 9 bolnikih. Pri 7. bolnikih smo uspešno naredili reintervencijo, pri dveh je reintervencija bila neuspešna. Trije bolniki (6,25%) so imeli ponovne krvavite, povezane z moteno prehodnostjo odvoda. Primarna prehodnost po 1 letu je 85,6%, primarna asistirana pa 95,2%. Primarna prehodnost po 4 letih je 67,4%, primarna asistirana pa 87,3%. Kumulativno preživetje je 83%, 79,9%, 79,9% in 73,5% po 1., 2., 3. in 4., letih (Kaplan-Meier). Vzroki smrti so napredujoča jetrna okvara pri 6 bolnikih, krvavitev pri dveh bolnikih in ostali vzroki pri 5 bolnikih. (Izvleček skrajšan pri 2000 znakih).
Deskriptorji		HYPERTENSION, PORTAL PORTASYSTEMIC SHUNT, TRANSJUGULAR INTRAHEPATIC POSTOPERATIVE COMPLICATIONS