Transjugular intrahepatic portosystemic shunt for the prevention of gastroesophageal variceal rebleeding in patients with cavernous transformation of portal vein

doi:10.3877/cma.j.issn.2095-2015.2021.01.007

Abstract

Abstract:

Objective

To evaluate the feasibility, efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPS)in preventing gastroesophageal variceal rebleeding in patients with cavernous transformation of portal vein(CTPV).

Methods

A total of 67 patients who were diagnosed as CTPV and with a history of esophageal varices bleeding, and who underwent TIPS to prevent rebleeding from January 2011 to December 2016 in Shandong Provincial Hospital were selected for retrospective analysis and follow-up.The technical success rate, complication rate, rebleeding, stent patency, hepatic encephalopathy and survival were summarized.

Results

TIPS was successfully performed in 56(83.6%)of the 67 CTPV patients.There were 15 cases via a transjugular approach alone, 33 cases via a combined transjugular/transhepatic approach, and 8 cases via a combined transjugular/transsplenic approach.After TIPS the mean portosystemic pressure gradient(PSG)decreased from(28.09±7.28)mmHg to(17.53±6.12)mmHg(P<0.01). The mean follow-up was(23.91±12.35)months.The cumulative non-bleeding rate was 87.0%, the stent patency rate was 81.5%, the hepatic encephalopathy incidence was 27.8%, and the cumulative survival rate was 88.9%.Among the 11 patients who did not receive TIPS successfully, 4 died and 4 rehemorrhaged.

Conclusion

TIPS is a safe, feasible and effective method for preventing gastroesophageal variceal rebleeding in patients with CTPV.

Key words: Cavernous transformation, Portal vein, Transjugular intrahepatic portosystemic shunt, Variceal bleeding, Portal hypertension

Sunyun Jin, Guangchuan Wang, Zhaopeng Li, Guangjun Huang, Cui Li, Gonghai Chen, Chunqing Zhang. Transjugular intrahepatic portosystemic shunt for the prevention of gastroesophageal variceal rebleeding in patients with cavernous transformation of portal vein[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2021, 11(01): 31-36.

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URL: https://zhxhbyyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-2015.2021.01.007

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Figures/Tables 4

References 20

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一般资料	数值
年龄(岁)	51.31±12.46
性别(男/女，例)	46/21
Child-Pugh A级/B级/C级(例)	30/33/4
Child-Pugh评分(±s)	6.85±1.50
脾切(是/否，例)	19/48
食管/食管胃底静脉曲张(例)	21/46
总胆红素(μmol/L，±s)	21.13±13.14
国际标准化比率(±s)	1.24±0.16
白蛋白(g/L，±s)	32.03±4.85
尿素氮(mmol/L，±s)	5.10±2.29
肌酐(μmol/L，±s)	61.40±19.06
血钠(mmol/L，±s)	139.88±4.30
凝血酶原时间(s，±s)	14.72±1.96
血红蛋白(g/L，±s)	90.18±21.58
白细胞(10^-9/L，±s)	53.50±4.17
血小板(10^-9/L，±s)	172.19±120.66
谷丙转氨酶(U/L，±s)	30.44±13.97
谷草转氨酶(U/L，±s)	21.32±11.72
碱性磷酸酶(U/L，±s)	91.34±47.00

一般资料	数值
年龄(岁)	51.31±12.46
性别(男/女，例)	46/21
Child-Pugh A级/B级/C级(例)	30/33/4
Child-Pugh评分(±s)	6.85±1.50
脾切(是/否，例)	19/48
食管/食管胃底静脉曲张(例)	21/46
总胆红素(μmol/L，±s)	21.13±13.14
国际标准化比率(±s)	1.24±0.16
白蛋白(g/L，±s)	32.03±4.85
尿素氮(mmol/L，±s)	5.10±2.29
肌酐(μmol/L，±s)	61.40±19.06
血钠(mmol/L，±s)	139.88±4.30
凝血酶原时间(s，±s)	14.72±1.96
血红蛋白(g/L，±s)	90.18±21.58
白细胞(10^-9/L，±s)	53.50±4.17
血小板(10^-9/L，±s)	172.19±120.66
谷丙转氨酶(U/L，±s)	30.44±13.97
谷草转氨酶(U/L，±s)	21.32±11.72
碱性磷酸酶(U/L，±s)	91.34±47.00

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