Efficacy analysis of transjugular intrahepatic portosystemic shunt in the treatment of esophago-gastric variceal bleeding complicated with cavernous transformation of the portal vein
10.3760/cma.j.cn311367-20210103-00004
- VernacularTitle:经颈静脉肝内门体分流术治疗食管-胃底静脉曲张破裂出血伴门静脉海绵样变的疗效分析
- Author:
Xiaochun YIN
1
;
Feng ZHANG
;
Jiangqiang XIAO
;
Yi WANG
;
Ming ZHANG
;
Yuzheng ZHUGE
Author Information
1. 南京大学医学院附属鼓楼医院消化内科 210008
- Keywords:
Portasystemic shunt, transjugular intrahepatic;
Cavernous transformation portal vein;
Esophageal and gastric variceal bleeding;
Safety;
Efficacy
- From:
Chinese Journal of Digestion
2021;41(10):685-691
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of esophago-gastric variceal bleeding (EGVB) complicated with cavernous transformation of portal vein (CTPV).Methods:From January 1, 2015 to December 31, 2018, the clinical data of liver cirrhosis patients with EGVB and complicated with (CTPV group) or without (non-CTPV group) CTPV receiving TIPS at Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School were retrospectively analyzed. The success rate of operation, stent patency rate, recurrent bleeding rate, incidence and survival rate of hepatic encephalopathy of CTPV group and non-CTPV group were analyzed. Independent samples t test, Mann-Whitney U test and chi-square test were used for statistical analysis. Kaplan-Meier method was used for survival analysis. Results:A total of 37 liver cirrhosis patients with EGVB and CTPV receiving TIPS treatment were screened out, among which 10 patients (27.0%) failed the portal vein puncture during the TIPS and switched to endoscopic treatment, the success rate was 73.0%. A total of 460 liver cirrhosis patients with EGVB and non-CTPV received TIPS treatment, among which TIPS in 18 patients (3.9%) was failed, and the success rate was 96.1%. With 1∶2 ratio propensity matching, 54 patients were enrolled in non-CTPV group. In the CTPV group, after TIPS treatment, the average portal vein pressure decreased from (28.9±5.1) mmHg (1 mmHg=0.133 kPa) to (18.8±4.5) mmHg, and the difference was statistically significant ( t=7.122, P<0.01). The median follow-up time was 33 months(1 to 66 months). There were no significant differences between the CTPV group and the non-CTPV group in one-year of cumulative stent patency rate (75.0% vs. 86.8%), recurrent upper gastrointestinal bleeding rate of hepatic encephalopathy (21.0% vs. 10.0%), the incidence of hepatic encephalopathy (34.8% vs. 22.2%) and the survival rate (80.7% vs. 88.9%)(all P >0.05). Conclusion:TIPS is safe and effective in the treatment of liver cirrhosis patients with EGVB and CTPV, and does not increase the incidence of postoperative complications and long-term mortality.
