Gastroenterology Department II or Hepatology Center, The 2nd Affiliated Hospital of Kunming Medical University, Kunming City, 650101, Yunnan Province, China.
Public Health Institute of Kunming Medical University, Kunming City, 650500, Yunnan Province, China.
Eur Radiol. 2019 Sep;29(9):5032-5041. doi: 10.1007/s00330-019-06046-6. Epub 2019 Feb 22.
Transjugular intrahepatic portosystemic shunt (TIPS) and partial splenic embolization (PSE) were two interventional radiological treatments for the complications of cirrhosis. This study aimed to investigate the effects of concomitant PSE on the long-term shunt patency and overall survival of TIPS-treated patients.
Forty-eight patients with TIPS insertion were enrolled and studied retrospectively. They were divided into TIPS+PSE (n = 16) and TIPS groups (n = 32), undergoing combined therapy using TIPS and PSE, and monotherapy using TIPS alone, respectively.
The 5-year cumulative primary patency rate in the TIPS+PSE group was markedly higher than in the TIPS group (56.8% vs. 32.8%, p = 0.028), whereas the 5-year cumulative secondary patency rate (93.8% vs. 87.7%, p = 0.749) and overall survival rate (62.5% vs. 30.7%, p = 0.414) were not significantly different between the two groups. Cox-regression models revealed that group (hazard ratio [HR], 0.235; 95% CI, 0.084-0.665; p = 0.006), portal venous pressure decline (HR, 0.687; 95% CI, 0.563-0.838; p = 0.000), and baseline portal vein thrombosis (HR, 3.955; 95% CI, 1.634-9.573; p = 0.002) were significant predictors for shunt dysfunction, while only ascites (HR, 2.941; 95% CI, 1.250-6.920; p = 0.013) was a significant predictor for mortality. No severe adverse event was noted in the two groups except for the potential risk of splenic abscess development in the TIPS+PSE group.
Concomitant PSE may help increase the long-term primary shunt patency rate, but not the overall survival of TIPS-treated patients. Further prospective studies are needed to validate these retrospective findings and to investigate the potential mechanisms.
• Combined therapy using TIPS and PSE is associated with higher primary patency rates than TIPS alone. • Combined therapy using TIPS and PSE is associated with similar rates of secondary patency and overall survival of patients than TIPS alone. • Group (TIPS alone or TIPS+PSE), PVD, and baseline PVT are three independent predictors for shunt dysfunction, while ascites is the only independent predictor for mortality.
经颈静脉肝内门体分流术（TIPS）和部分性脾动脉栓塞术（PSE）是两种治疗肝硬化并发症的介入放射学治疗方法。本研究旨在探讨 PSE 联合治疗对 TIPS 治疗患者的长期分流通畅率和总生存率的影响。
回顾性纳入 48 例接受 TIPS 置入术的患者，并进行研究。他们被分为 TIPS+PSE（n=16）和 TIPS 组（n=32），分别采用 TIPS 和 PSE 联合治疗以及单纯 TIPS 治疗。
TIPS+PSE 组的 5 年累积主通畅率明显高于 TIPS 组（56.8%比 32.8%，p=0.028），而 5 年累积次通畅率（93.8%比 87.7%，p=0.749）和总生存率（62.5%比 30.7%，p=0.414）在两组间无显著差异。Cox 回归模型显示，分组（风险比 [HR]，0.235；95%CI，0.084-0.665；p=0.006）、门静脉压力下降（HR，0.687；95%CI，0.563-0.838；p=0.000）和基线门静脉血栓形成（HR，3.955；95%CI，1.634-9.573；p=0.002）是分流功能障碍的显著预测因素，而仅腹水（HR，2.941；95%CI，1.250-6.920；p=0.013）是死亡的显著预测因素。除 TIPS+PSE 组有发生脾脓肿的潜在风险外，两组均未出现严重不良事件。
TIPS 联合 PSE 治疗可能有助于提高 TIPS 治疗患者的长期主分流通畅率，但对总生存率无影响。需要进一步的前瞻性研究来验证这些回顾性发现，并探讨潜在的机制。
TIPS 和 PSE 联合治疗与单纯 TIPS 治疗相比，其主分流通畅率更高。
TIPS 和 PSE 联合治疗与单纯 TIPS 治疗相比，其次分流通畅率和患者总生存率相似。
分组（单纯 TIPS 或 TIPS+PSE）、门静脉血流动力障碍（PVD）和基线门静脉血栓形成（PVT）是分流功能障碍的三个独立预测因素，而腹水是死亡的唯一独立预测因素。
