Author/Editor		Šurlan, Miloš; Jereb, Janez; Ključevšek, Tomaž; Berden, Pavel; Klančar, Janez
Title		Transjugularni intrahepatalni portosistemski šant
Translated title		Transjugular intrahepatic portosystemic shunt
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 38, št. Suppl 3
Publication year		1999
Volume		str. 69-76
Language		slo
Abstract		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 esophageal varices and inveterate ascites. Relative indications, on the other hand, are splenomegaly with hypersplenism, Budd-Chairi syndome, emergencies before 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 procedure, the level of dysfunction of the liver, right heart and kidneys is determined. Biochemical and blood tests including blood coagulation test are made, the ammonia level in the serum is determined and possible obstructions/strictures of the portal are checked. A detailed description of the procedure, care for patient and postprocedure monitoring is given. The success rate of the procedure is between 93% and 100% and the mortality rate within 30 days due to TIPS is between 1% and 3%. Hemorrhage is stopped in 95% to 100%, ascites is improved in 87% to 92% and the kidney function is improved in 81%. In case of hypersplensim the trombocytopenia is improved in 75% by TIPS and leucopenia in 50% of patients. There are relatively few complications are mostly due to stricture and obstruction of the shunt. After two-years the shunt is patient in 50% of patients. In a group of 29 patients who were trated in the period of four years with an average monitoring period of two years, 22 patients (75.9%) are still alive and only 7 died (24.1%). Six of the dead patients suffered from alcoholic cirrhosis of the liver. In two cases the cause of death was not related to the TIPS or cirrhosis of the liver.
Summary		V preglednem prispevku avtorji prikazujejo indikacije in kontraindikacije za transjugularni intrahepatalni portosistemski šant, ki jih delimo na absolutne in relativne. Absolutne indikacije so sveža in ponovna krvavitev iz varic požiralnika in trdovratni ascites. Relativne indikacije so splenomegalija s hipersplenizmom, Budd-Chiariev sindrom, preprečevanje zapletov pred presaditvijo jeter in hepatorenalni sindrom. Absolutni kontraindikaciji sta huda okvara jeter in odpoved desnega srca, relativne pa so policistična degeneracija jeter, novotvorbe, zapora portalne vene in hujša lokalna ali sistemska okužba. Pred posegom določimo stopnjo okvare jeter, desnega srca in ledvic, naredimo biokemične in krvne preiskave s testi koagulacije ter določimo koncentracijo amonjaka 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 transjugularnega intrahepatalnega portosistemskega šanta je 1-3%. Krvavitev ustavimo v 95-100%, ascites se izboljša v 87-92% in ledvično delovanje v 81%, pri hipersplenizmu se trombocitopenija izboljša pri 75% in levkopenija pri 50% bolnikov. Zapletov ob posegu je relativno malo, več jih je kasneje zaradi zožitev in zapor šanta. Po dveh letih je šant prehoden pri 50% bolnikov. V naši skupini 29 bolnikov, zdravljenih v obdobju štirih let, s povprečnim časom opazovanja 2 leti je še živih 22 (75,9%) bolnikov, umrlo jih je 7 (24,1%). Šest umrlih bolnikov je imelo alkoholno cirozo jeter pri dveh bolnikih pa vzrok smrti ni bil povezan s transjugularnim intrahepatalnim portosistemskim šantom oziroma cirozo jeter.
Descriptors		HYPERTENSION, PORTAL ANGIOGRAPHY PORTASYSTEMIC SHUNT, TRANSJUGULAR INTRAHEPATIC ESOPHAGEAL AND GASTRIC VARICES LIVER CIRRHOSIS, ALCOHOLIC