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Transjugular intrahepatic portosystemic shunt and splenectomy are more effective than endoscopic therapy for recurrent variceal bleeding in patients with idiopathic noncirrhotic portal hypertension

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World Journal of Clinical Cases 2020年第10期8卷 1871-1877页

作者： Fu-Liang He Rui-Zhao Qi Yue-Ning Zhang Ke Zhang Yu-Zheng Zhu-Ge Min Wang Yu Wang Ji-Dong Jia Fu-Quan Liu Department of Hepatology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China Department of General Surgery Fifth Medical Center of PLA General HospitalBeijing 100039China Department of Gastroenterology Beijing You’an HospitalCapital Medical UniversityBeijing 100069China Department of General Surgery Beijing Ditan HospitalCapital Medical UniversityBeijing 100102China Department of Gastroenterology Nanjing Drum Tower Hospitalthe Affiliated Hospital of Nanjing University Medical SchoolNanjing 210008Jiangsu ProvinceChina Department of Interventional Therapy Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS),splenectomy plus esophagogastric devascularization(SED)and endoscopic therapy+non-selectiveβ-blockers(ET+NSBB)are widely applied in secondary prevention of recurrent gastroesophageal variceal bleeding in patients with liver *** different treatments,however,have not been compared in patients with idiopathic noncirrhotic portal hypertension(INCPH).AIM To compare the outcomes of TIPS,SED and ET+NSBB in the control of variceal rebleeding in patients with *** This retrospective study recruited patients from six centers across *** characteristics,baseline profiles and follow-up clinical outcomes were ***-procedural clinical outcomes,including incidence of rebleeding,hepatic encephalopathy(HE),portal vein thrombosis(PVT)and mortality rates,were compared in the different *** In total,81 patients were recruited,with 28 receiving TIPS,26 SED,and 27 ET+*** significant differences in demographic and baseline characteristics were found among these three groups before the *** treatment,blood ammonia was significantly higher in the TIPS group;hemoglobin level and platelet count were significantly higher in the SED group(P<0.01).Rebleeding rate was significantly higher in the ET+NSBB group(P<0.01).Mortality was 3.6%,3.8%and 14.8%in the TIPS,SED and ET+NSBB groups,respectively,with no significant differences(P=0.082).Logistic regression analysis showed that mortality was significantly correlated with rebleeding,HE,portal thrombosis and superior mesenteric vein thrombosis(P<0.05).CONCLUSION In patients with INCPH,TIPS and SED were more effective in controlling rebleeding than ET+NSBB,but survival rates were not significantly different among the three *** was significantly correlated with rebleeding,HE and PVT.

关键词： Idiopathic non-cirrhotic portal hypertension Transjugular intrahepatic portosystemic shunt splenectomy plus esophagogastric devascularization Endoscopic therapy Survival

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