Abstract
To assess the long term prognosis of transjugular intrahepatic portosystemic shunt (TIPS), a total of 28 patients with portal hypertension who had been treated with TIPS were studied. Of these, 16 patients underwent TIPS for esophago-gastric varices, 10 for refractory ascites and two for portal hypertensive gastropathy. Six of these patients were complicated with hepatocellular carcinoma. Child-Pugh score of 26 patients who survived 1 year or longer after TIPS was 8.4 before TIPS, 8.0 at 4 weeks and 8.8 at 1 year. Score of ascites was significantly improved after TIPS. A shunt occlusion rate was as high as 60.7%. However, shunt obstruction was accessible for a second intervention. Overall patency was 96% at 1 year, 96% at 2 years and 87% at 3 years. One patient had rebleeding of varices after TIPS. Survival rates were 92% at 1 year, 40% at 3 years and 30% at 5 years. A mean survival period was 27 months. Overall, 15 patients died : 6 patients died of hepatic failure and 4 patients died of hepatocellular carcinoma. Because Child-Pugh score showed no significant change before and after the procedure, TIPS appears to be safe and effective for portal hypertension which is difficult to be controlled by other treatments.
