BACKGROUND:Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established therapeutic option for the management of variceal hemorrhage in patients with cirrhosis. The simultaneous migration of the coil and n-butyl-2-cyanoacrylate (NBCA) is an extremely rare but significant complication after TIPS. Because of its rare presentation, there are currently no definitive recommendations for the management of this condition.CASE PRESENTATION:A 46-year-old man with hepatitis B cirrhosis underwent TIPS placement for uncontrolled gastroesophageal varix (GEV) bleeding secondary to portal hypertension in August 2018. During the procedure, large GEVs were embolized using a coil and NBCA. After a year, coil and NBCA migration into the stomach was observed. Attempts to remove the coil using biopsy forceps during esophagogastroduodenoscopy failed. The patient refused further intervention on the coil to prevent further complications and received conservative therapy instead. Close surveillance with endoscopy is recommended for detecting coils and varices.CONCLUSIONS:The present case reports an extremely rare but significant complication after TIPS, which highlights the management and follow-up recommendation for such rare complications. Our experience may provide guidance for the management of future similar cases and stimulate discussion about treatment methods of similar patients.

目的 采用meta分析方法对比TIPS联合胃冠状静脉栓塞术(GCVE)与单独TIPS治疗肝硬化门静脉高压(PTH)上消化道出血(UGH)的中远期疗效.方法 检索中国知网、万方医学网、中国生物医学文献数据库、维普数据库、PubMed、Embase、Cochrane Library、Web of Science 数据库自建立至 2021 年 12 月 31 日有关对比 TIPS 联合 GCVE(试验组)与单独TIPS(对照组)治疗肝硬化PTH伴UGH疗效的相关文献;依据纳入及排除标准筛选文献,并提取相关数据,采用RevMan 5.3及Stata 14.0软件进行meta分析.结果 最终纳入文献17篇,总样本量为1 486例,包括试验组803例、对照组683例.meta分析结果显示,试验组治疗后6～12个月再次出血率[RR=0.32,95％CI(0.24,0.42),P＜0.000 01]、支架闭塞或狭窄率[RR=0.59,95％CI(0.39,0.89),P=0.01]及肝性脑病发生率[RR=0.54,95％CI(0.40,0.75),P=0.002]均低于对照组.结论 TIPS联合GCVE可有效降低肝硬化PHT伴UGH患者中远期再次出血率、支架闭塞或狭窄率及肝性脑病发生率.

OBJECTIVE:To evaluate the clinical efficacy of infusion of gemcitabine (GEM) and fluorouracil (5-FU)through the celiac artery and superior mesenteric artery in the treatment of pancreatic carcinoma (PC).METHODS:We analyzed 20 patients diagnosed clinically or pathologically with PC, without metastases, who had an estimated survival duration of >3 months in our department from May 2009 to December 2014. Nine patients were treated directly without surgical resection of the tumor, while the other 11 patients were treated after surgery. In all patients, the femoral artery was punctured using the Seldinger technique, and a catheter was placed in the opening of the celiac artery or the superior mesenteric artery. We administered 500 ​mg/m2 GEM and 500 ​mg/m2 5-FU. Observational data included data on clinical efficacy and survival rates during the follow-up period of 3-72 months.RESULTS:Twenty patients were treated 85 times with transcatheter arterial infusion chemotherapy (TAI). The survival rates were 80%, 40%, 35%, 20%, 10%, and 5% at 3, 6, 12, 24, and 72 months, respectively.CONCLUSION:TAI chemotherapy with GEM and 5-FU may be a therapeutic option for the treatment of PC.

目的:研究国产载药微球经导管肝动脉内化疗栓塞术(T A C E)治疗乏血供肝癌的疗效及安全性.方法:对30例肝脏增强CT及DSA造影诊断为乏血供肝癌并应用国产CalliSpheres载药微球经介入栓塞的患者,分析介入手术之前以及随访的所有相关检查资料.结果:30例患者手术成功率为100％,随访2月,介入后2月的疾病缓解率及疾病控制率分别为70％和85％.与介入前相比,介入后甲胎蛋白指标明显降低,有统计学意义(P<0.05).术后并发症多为恶心呕吐、低热、腹部胀痛等栓塞综合征.结论:国产载药微球经TACE治疗乏血供肝癌是一种安全的以及短期效果良好的治疗方案.

目的:研究介入栓塞治疗W h i p p l e术后出血的安全性及有效性.方法:选取2012年1月—2018年2月本中心因胰腺Whipple术后出血行DSA造影检查的40例患者作为研究对象,男35例,女5例,平均年龄55岁,临床症状均为腹腔出血.评价介入栓塞术的疗效、再出血以及相关严重并发症.结果:32例患者造影为阳性表现,均予弹簧圈栓塞.介入治疗手术成功率为96.9％(31/32),临床成功率为78.1％(25/32),再出血率为21.9％(7/32).所有患者介入栓塞术后未出现肝功能衰竭、胃肠道缺血坏死等并发症.介入栓塞术后1月内死亡率为9.4％(3/32).结论:介入栓塞术是治疗胰腺W h i p p l e术后出血的一种安全及有效的治疗方案,大多数病人通过介入弹簧圈栓塞治疗可止血成功.

目的:探讨国产CalliSpheres载药微球治疗肝癌的近期疗效性及安全性.方法:对60例肝癌患者应用国产载药微球治疗,回顾性分析术前及随访的临床资料、实验室检查资料及影像学检查资料.结果:60例患者手术成功率为100％,随访时间为1月,术后1月的疾病缓解率(CR+PR)分别为80％,疾病控制率(CR+PR+SD)分别为95％.术后AFP水平明显下降,差异有统计学意义(P<0.05).术后并发症以发热、腹痛等栓塞综合征为主.结论:国产CalliSpheres载药微球治疗肝癌是安全有效的,远期疗效待进一步研究.

目的:评价两种载药微球经肝动脉化疗栓塞术治疗原发性肝癌(H C C)的有效性及安全性.方法:回顾2017年9月—2018年3月本中心60例行D-TACE治疗的HCC患者,根据载药微球种类将其分为A组(30例,DC Bead)和B组(30例,CalliSpheres).分析并比较两组患者术后1月的甲胎蛋白(AFP)及影像学变化,采用改良实体瘤疗效评价标准评估其临床疗效.结果:随访患者1月,A组疾病缓解率为70％,疾病控制率为90％,B组疾病缓解率为73.3％,疾病控制率为93.3％,差异无统计学意义(P>0.05);两组A F P均较术前降低,术后并发症以发热、恶心呕吐、腹痛为主,均未见严重并发症.结论:两种载药微球临床疗效及安全性均较好,无明显差异,远期疗效待进一步观察.