Abstract
This study was performed to investigate the results of long-term treatment with a transjugular intrahepatic portosystemic shunt (TIPS) to determine the indications for this treatment. The study subjects comprised 20 patients who had undergone TIPS between 1993 and 2007. TIPS was performed for refractory ascites in 13 patients, refractory varices in 5, and refractory pleural effusion and PHG in 1 patient each. A shunt was placed between the hepatic vein and the portal vein branch. The portal vein pressure after TIPS was significantly reduced. Encephalopathy was observed in 10 patients, but it was controllable. The efficacy rate of TIPS for ascites was 84.6%, and pleural effusion completely disappeared following TIPS. Refractory varices showed negative red color signs. Shunt malfunction was found in 9 patients (45.0%), with a patency rate of 68.8% at 1 year and 50.4% at 3 years. The survival rate was 72.2% at 1 year, 46.8% at 3 years, and 18.7% at 5 years. The prognoses of alcoholic cirrhotic patients were good. On the other hand, the prognoses of patients with viral cirrhosis and those with preoperative total bilirubin values of more than 2.5 mg/dL were poor, and the causes of death included hepatic failure in 13 patients and hemobilia in 1 patient. Accordingly, TIPS is favorably applied for treatment of alcoholic cirrhosis, but it should be performed with caution for the treatment of viral cirrhosis and severe hepatic impairment. Although the incidence of shunt malfunction is high, the malfunction is recoverable, and its early detection is important.
