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Prognosis after splenectomy plus pericardial devascularization vs transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding

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世界胃肠外科杂志:英文版(电子版) 2023年第8期15卷 1641-1651页

作者： Wei-Li Qi Jun Wen Tian-Fu Wen Wei Peng Xiao-Yun Zhang Jun-Yi Shen Xiao Li Chuan Li Department of Liver Surgery West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina Section for HepatoPancreatoBiliary Surgery Department of General SurgeryThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong University&The Second Affiliated Hospital of ChengduChongqing Medical UniversityChengdu 610041Sichuan ProvinceChina Department of Interventional Therapy West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina Department of Interventional Therapy National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100000China

BACKGROUND Portal hypertension combined with esophagogastric variceal bleeding(EGVB)is a serious complication in patients with hepatitis B virus(HBV)-related cirrhosis in *** plus pericardial devascularization(SPD)and transjugular intrahepatic portosystemic shunt(TIPS)are effective treatments for ***,a comparison of the effectiveness and safety of those methods is *** To compare the prognosis after SPD vs TIPS for acute EGVB after failure of endoscopic therapy or secondary prophylaxis of variceal rebleeding(VRB)in patients with HBV-related cirrhosis combined with portal *** This retrospective cohort study included 318 patients with HBV-related cirrhosis and EGVB who underwent SPD or TIPS at West China Hospital of Sichuan University during *** score-matched analysis(PSM),the Kaplan-Meier method,and multivariate Cox regression analysis were used to compare overall survival,VRB rate,liver function abnormality rate,and hepatocellular carcinoma(HCC)incidence between the two patient *** The median age was 45.0 years(n=318;226(71.1%)males).During a median follow-up duration of 43.0 mo,18(11.1%)and 33(21.2%)patients died in the SPD and TIPS groups,*** PSM,SPD was significantly associated with better overall survival(OS)(P=0.01),lower rates of abnormal liver function(P<0.001),and a lower incidence of HCC(P=0.02)than *** VRB rate did not differ significantly between the two groups(P=0.09).CONCLUSION Compared with TIPS,SPD is associated with higher postoperative OS rates,lower rates of abnormal liver function and HCC,and better quality of survival as acute EGVB treatment after failed endoscopic therapy or as secondary prophylaxis of VRB in patients with HBV-related cirrhosis combined with portal *** is no significant between-group difference in VRB rates.

关键词： Portal hypertension Liver cirrhosis esophagogastric variceal bleeding Splenectomy Pericardial devascularization Transjugular intrahepatic portosystemic shunt

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Efficacy of transjugular intrahepatic portosystemic shunts in treating cirrhotic esophageal-gastric variceal bleeding

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World Journal of Gastrointestinal Surgery 2024年第2期16卷 471-480页

作者： Xiao-Gang Hu Jian-Ji Dai Jun Lu Gang Li Jia-Min Wang Yi Deng Rui Feng Kai-Ping Lu Department of Interventional Radiology The Affiliated Jinhua HospitalZhejiang University School of MedicineJinhua 321000Zhejiang ProvinceChina Department of Interventional Medicine Zhejiang Provincial People’s HospitalPeople’s Hospital of Hangzhou Medical CollegeHangzhou 310000Zhejiang ProvinceChina Department of Vascular Surgery Zhejiang Provincial People’s HospitalPeople’s Hospital of Hangzhou Medical CollegeHangzhou 310000Zhejiang ProvinceChina

BACKGROUND Esophageal-gastric variceal bleeding(EGVB)represents a severe complication among patients with cirrhosis and often culminates in fatal ***-tional therapy,a rapidly developing treatment modality over the past few years,has found widespread application in clinical practice due to its minimally inva-sive ***,whether transjugular intrahepatic portosystemic shunt(TIPS)treatment has an impact on patient prognosis remains *** A retrospective study was conducted on ninety-two patients presenting with cirrhotic EGVB who were admitted to our hospital between September 2020 and September *** on the different modes of treatment,the patients were assigned to the study group(TIPS received,n=50)or the control group(per-cutaneous transhepatic varices embolization received,n=42).Comparative ana-lyses were performed between the two groups preoperatively and one month postoperatively for the following parameters:Varicosity status;hemodynamic parameters[portal vein flow velocity(PVV)and portal vein diameter(PVD);platelet count(PLT);red blood cell count;white blood cell count(WBC);and hepatic function[albumin(ALB),total bilirubin(TBIL),and aspartate transaminase(AST)].The Generic Quality of Life Inventory-74 was utilized to assess quality of life in the two groups,and the 1-year postoperative rebleeding and survival rates were *** Following surgical intervention,there was an improvement in the incidence of varicosity compared to the preoperative status in both ***,the study group exhibited more pronounced enhancements than did the control group(P<0.05).PVV increased,and PVD decreased compared to the preoperative values,with the study cohort achieving better outcomes(P<0.05).PLT and WBC counts were elevated postoperatively in the two groups,with the study cohort displaying higher PLT and WBC counts(P<0.05).No differences were detected between the two groups in terms of serum ALB,TBIL,or AST lev

关键词： Liver cirrhosis esophagogastric variceal bleeding Transjugular intrahepatic portosystemic shunt Prognosis

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