520 KB22 KB199220252000Jereb, JanezŠurlan, Milošštevilka:2letnik:34str. 93-99COBISSID:11709401ISSN:1318-2099URN:URN:NBN:SI:doc-NMIEWXMXenCroatian Medical Association - Croatian Society of RadiologySlovenian Medical Society - Section of RadiologyRadiology and oncology (Ljubljana)bolezniEsophageal and gastric varicesgastroenterologijaHepatic encephalopathyHepatomegalyHepatorenal syndromeIntraoperative complicationsjetraLiver transplantationožiljePatient selectionPortasystemic shunt, transjugular intrahepaticSplenomegalyTIPSTreatment outcomevaricezdravljenjeTransjugular intrahepatic portosystemic shunt (TIPS)|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 ascites. Relative indications, on the other hand, are splenomegaly with hypersplenism, Budd-Chiari syndrome, liver transplantation and hepatorenal syndrome. Absolutecontraindications are severe liver dysfunction and right heart failure, while the relative ones polycystic liver degeneration, neoplasm, obstruction of the portal vein and severe local and systemic infection. Beforethe TIPS procedure, the level of dysfunction of the liver, right heart and kidneys is determined. Biochemical and blood tests, 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 patient and a operative monitoring are given. The success rate of the procedure is between 93% and 100% and the mortality rate within 30 days because TIPS is between 1% and 3%. The hemorrhage is stopped in 95% to 100%, the ascites is improved in 87% to 92% and the kidney function in 81%. In case of hypersplenism the thrombocytopenia is improved in 75% and leucopenia in 50% of patients. There are relatively fewcomplications during the procedure. Postoperative complications are more frequent due to stricture and obstruction of the shunt. After a two-year treatment the shunt is passable in 50% of patients. Thus, in a group of 29 patients, who were treated in the period of four years with an average monitoring period of two years, 22 patients (75,9%) are still alive and only 7died (24,1%). Six of dead patients suffered from alcoholic cirrhosis of the liver. In two cases the cause of death was not related to the TIPS and the cirrhosis of the liver. (Abstract truncated at 2000 characters)Izhodišča. Avtorji prikazujejo indikacije in kontraincikacije 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-Chariev 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 amoniaka v serumu in preverimo prehodnost portalne vene. Natančno je pisana izvedba posega, skrb za bolnika in njegovo spremljanje po posegu. Poseg je uspešen 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 jekasneje 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 (75,9%) bolnikov, umrlo jih je 7 (24,1%). Šest umrlih bolnikov je imelo alkoholno cirozo jeter, pri dveh bolnikih pa vzrok smrti ni povezan s transjugularnim intrahepatalnim portosistemskim šantom oziroma cirozo jeter. Zaključki. TIPS je zlasti učinkovita metoda za ustavljanje svežih varikoznih krvavitev. (Izvleček prekinjen pri 2000 znakih)TEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaOnkološki inštitut Ljubljana