Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China.
Department of Radiology, Air Force Medical Center of PLA, Beijing 100142, China.
World J Gastroenterol. 2019 Mar 7;25(9):1088-1099. doi: 10.3748/wjg.v25.i9.1088.
Transjugular intrahepatic portosystemic shunt (TIPS) is currently used for the treatment of complications of portal hypertension. The incidence of hepatic encephalopathy (HE) remains a problem in TIPS placement. It has been reported that the right branch mainly receives superior mesenteric venous blood while the left branch mainly receives blood from the splenic vein. We hypothesized that targeted puncture of the left portal vein would divert the non-nutritive blood from the splenic vein into the TIPS shunt; therefore, targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE.
To evaluate the influence of targeted puncture of left branch of portal vein in TIPS on HE.
A retrospective analysis of 1244 patients with portal-hypertension-related complications of refractory ascites or variceal bleeding who underwent TIPS from January 2000 to January 2013 was performed. Patients were divided into group A (targeting left branch of portal vein, = 937) and group B (targeting right branch of portal vein, = 307). TIPS-related HE and clinical outcomes were analyzed.
The symptoms of ascites and variceal bleeding disappeared within a short time. By the endpoint of follow-up, recurrent bleeding and ascites did not differ significantly between groups A and B ( = 0.278, = 0.561, respectively). Incidence of HE differed significantly between groups A and B at 1 mo (14.94% 36.80%, = 4.839, = 0.028), 3 mo (12.48% 34.20%, = 5.054, = 0.025), 6 mo (10.03% 32.24%, = 6.560, = 0.010), 9 mo (9.17% 31.27%, = 5.357, = 0.021), and 12 mo (8.21% 28.01, = 3.848, = 0.051). There were no significant differences between groups A and B at 3 years (6.61% 7.16%, = 1.204, = 0.272) and 5 years (5.01% 6.18%, = 0.072, = 0.562). The total survival rate did not differ between groups A and B ( = 0.226, = 0.634, log-rank test).
Targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE but has no direct influence on prognosis of portal-hypertension-related complications.
经颈静脉肝内门体分流术（TIPS）目前用于治疗门静脉高压症的并发症。肝性脑病（HE）的发生率仍然是 TIPS 放置的一个问题。据报道，右支主要接收肠系膜上静脉的血液，而左支主要接收来自脾静脉的血液。我们假设，对门静脉左支的靶向穿刺将使来自脾静脉的非营养性血液分流到 TIPS 分流中；因此，TIPS 过程中对门静脉左支的靶向穿刺可能会降低 HE 的风险。
评估 TIPS 中门静脉左支靶向穿刺对 HE 的影响。
回顾性分析了 2000 年 1 月至 2013 年 1 月期间因难治性腹水或静脉曲张出血而行 TIPS 的 1244 例门静脉高压相关并发症患者。患者分为 A 组（靶向门静脉左支， = 937）和 B 组（靶向门静脉右支， = 307）。分析 TIPS 相关 HE 和临床结果。
腹水和静脉曲张出血的症状在短时间内消失。在随访终点时，A 组和 B 组的复发性出血和腹水无显著差异（=0.278，=0.561，分别）。A 组和 B 组在 1 个月（14.94% 36.80%，=4.839，=0.028）、3 个月（12.48% 34.20%，=5.054，=0.025）、6 个月（10.03% 32.24%，=6.560，=0.010）、9 个月（9.17% 31.27%，=5.357，=0.021）和 12 个月（8.21% 28.01%，=3.848，=0.051）时 HE 的发生率有显著差异。A 组和 B 组在 3 年（6.61% 7.16%，=1.204，=0.272）和 5 年（5.01% 6.18%，=0.072，=0.562）时无显著差异。A 组和 B 组的总生存率无差异（=0.226，=0.634，对数秩检验）。
TIPS 过程中对门静脉左支的靶向穿刺可能降低 HE 的风险，但对门静脉高压相关并发症的预后无直接影响。
