| Objective:To investigate clinical efficacy and prognostic factors of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of patients with refractory ascites.Methods:1. Research object:According to inclusion and exclusion criteria, retrospective analysed patients of refractory ascites that underwent TIPS treatment successfully in infectious department of the Second Affiliated Hospital of Chongqing Medical University, totally included 23 cases.2. Follow-up plans and indicators:The ascites, serum parameters(platelet, albumin, total bilirubin, creatinine, prothrombin time, et al), case of hepatic encephalopathy, abdominal ultrasound, abdominal computed tomography were recorded before and after operation(in one week, one month, three months, six months, twelve months, eighteen months, and every six months as a interval afterward).3. Therapeutic effect of ascites evaluation criteria:In our study, massive ascites reduced to medium or mild volume which was evaluated ascites effective control, and medium ascites was found in three months after TIPS was considered incomplete response.4. Statistical method:Paired t test and nonparametric test were used to analyze of the changes in clinical serological indexes before and after TIPS. The survival rate was calculated by Kaplan-Merier method. The preoperative risk factors were used to predict the therapy effect of ascites in three months by logistic regression analysis. Multiple factors COX regression was used to analyze the influence of preoperative risk factors on postoperative survival. ROC and AUC determined the best prediction value.Results:1. Patient follow-up information:Totally 23 patients with consecutive postoperative refractory ascites were followed up for an average of 9.7 months(range from 1-26 month). One patient dead and one patient lost to follow up in 3months after operation. Three patients dead accumulatively in 6 months after operation. Four patients dead accumulatively and one case lost to follow up in 12 months after operation.2. Remission of ascites:The ascites of patients during the first year after operation improved than those of pre-operation. The ascites of 19 patient (82.6%) were effectively controlled one month after operation. Thirteen patients (52.4%) and 23 patients (100%) had a small amount of ascites after 3 month and 6 month respectively.3. Postoperative biochemical indexes:The hepatic functions were damaged in a short time about one week after TIPS,but gradually recoverd within the next month (prothrombin time prolonged, Z=-2.419, P=0.016, median(minimum,maximum)=19.6(14.0,28.7); Child-Pugh scores increased, t=-2.714, P=0.013,x±S=9.87±1.71; total bilirubin rised, Z=-3.711, P=0.000, median (minimum,maximun)=37.0(13.2,204.3)).4. Analysis of prognostic factors:The 3 months,6 months and 1 year cumulative survival rate were 95.5%,85.9%and 78.1%respectively. COX regression analysis showed that serum bilirubin(P=0.007, HR=1.049, 95%CI=1.012-1.086) and sodium levels(P=0.027, HR= 0.677, 95%CI=0.479-0.956) were independent risk factors associated with survival rate by using multivariate analysis. According to ROC and AUC analysis,we selected the cut-off values of 37 μmol//L for serum bilirubin level (AUC=0.676, sensitivity=66.7%, specificity=94.1%,95%CI=0.335-1.000). In addition, Kaplan-Meier survival analysis demonstrated that the one year cumulative survival in patients with serum bilirubin level<37 μmol/L was 92.3% as compared to 25% in patients with serum bilirubin level>37 μmol/L.Conclusion:TIPS is an effective programme of treatment for refractory ascites. The hepatic functions will be damaged in a short term after TIPS. The serum bilirubin level above 37 μmol/L is a prognostic factor of one year cumulative survival in patients with cirrhosis and refractory ascites treated with TIPS, and which should be clinical basis for a judgment of prognosis. |
PDF Full Text Request