Clinical efficacy of TIPS combined with main splenic artery embolization in the treatment of portal hypertension upper gastrointestinal bleeding complicated with extensive portal vein thrombosis
10.3760/cma.j.cn113884-20250321-00092
- VernacularTitle:TIPS联合脾动脉主干栓塞术治疗门静脉高压症上消化道出血合并广泛性门静脉血栓患者的疗效分析
- Author:
Mingming MENG
1
;
Zhibin WANG
;
Yifan LYU
;
Bing ZHU
;
Bowen LIU
;
Hua TIAN
;
Dongze LI
;
Fuchuan WANG
;
Ke ZHANG
;
Li JIANG
;
Huiguo DING
;
Yuening ZHANG
;
Ying HAN
;
Fuquan LIU
Author Information
1. 首都医科大学附属北京世纪坛医院消化内科，北京 100038
- Publication Type:Journal Article
- Keywords:
Hypertension, portal;
Thrombosis;
Transjugular intrahepatic portosystemic shunt;
Main splenic artery embolization;
Gastrointestinal bleeding
- From:
Chinese Journal of Hepatobiliary Surgery
2025;31(7):487-491
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with main splenic artery embolization in the treatment of patients with portal hypertension upper gastrointestinal bleeding complicated with extensive portal vein thrombosis (PVT).Methods:This study was a prospective, single-center, open-label, single-arm clinical trial. In the first phase, 81 patients with portal hypertension upper gastrointestinal bleeding who were admitted to Beijing Shijitan Hospital, Capital Medical University from January 2018 to December 2018 were consecutively enrolled, including 57 males and 24 females, with the age of (51.3±10.4) years. During TIPS surgery, the pressure of the portal vein before and after the balloon blocking the splenic artery was measured to clarify the contribution of the splenic artery to portal hypertension. In the second stage, from January 2019 to December 2022, 104 patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT were re-enrolled, including 71 males and 33 females, with the age of (50.9±12.5) years. TIPS combined with main splenic artery embolization was performed, and portal vein pressure was measured before and after embolization. Follow up on the postoperative esophageal and gastric varices of the patients in the second stage.Results:The portal vein pressures before and after the first stage of balloon occlusion of the splenic artery were (35.2±8.4) mmHg (1 mmHg=0.133 kPa) and (24.2±6.3) mmHg, respectively. The pressure after occlusion was lower than that before occlusion, and the difference was statistically significant ( t=10.54, P<0.001). The portal vein pressures before and after the second stage embolization were (36.1±9.5) mmHg and (21.1±4.7) mmHg respectively. The pressure after embolization was lower than that before embolization, and the difference was statistically significant ( t=13.47, P<0.001). In the second stage, among the 104 patients, the proportion of those whose varicose veins disappeared or improved 6 months after the operation was 43.3%(45/104) and 51.0%(53/104), respectively. There were no patients with aggravation or rebleeding due to rupture. One year later, 8 patients (7.7%) had aggravated or ruptured esophageal and gastric varices with bleeding. Two years later, 12 patients (11.5%) had aggravated or bleeding. Conclusion:TIPS combined with main splenic artery embolization can effectively reduce the portal vein pressure in patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT, improve the degree of esophageal and gastric varices, and reduce the risk of gastrointestinal bleeding.
