Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China.
Department of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China.
Hepatobiliary Pancreat Dis Int. 2021 Apr;20(2):128-136. doi: 10.1016/j.hbpd.2020.12.016. Epub 2021 Jan 5.
Studies about treatment of patients with chronic portal vein thrombosis (CPVT) are still limited, especially in different types of CPVT. This study aimed to evaluate the effect of transjugular intrahepatic portosystemic shunt (TIPS) in all types of CPVT with variceal bleeding.
Patients with CPVT who received TIPS treatment between January 2011 and June 2019 were divided into four types according to the extent of thrombosis. All patients had a history of variceal bleeding. The characteristics and clinical parameters were collected and recorded. Data on procedure success rate, variation in portal vein pressure, rebleeding, hepatic encephalopathy (HE), stent stenosis, and overall mortality were analyzed.
A total of 189 patients were included in this study (39 in type 1, 84 in type 2, 48 in type 3, 18 in type 4). The TIPS procedure success rate was 86.2%. The success rate was significantly different among the four types (89.7% vs. 88.1% vs. 83.3% vs. 77.8%, P = 0.001). In the TIPS success group, portal vein pressure was significantly reduced from 27.15 ± 6.59 to 19.74 ± 6.73 mmHg after the procedure (P < 0.001) and the rebleeding rate was significantly lower than that of the fail group (14.7% vs. 30.8%, P = 0.017). In addition, there were no significant differences in HE rate (30.7% vs. 26.9%, P = 0.912) or overall mortality (12.9% vs. 19.2%, P = 0.403) between the TIPS success group and the fail group. In the TIPS success group, we found that the occurrence of HE was significantly different (P = 0.020) among the four types, while there were no significant differences in rebleeding rate (P = 0.669), stent stenosis rate (P = 0.056), or overall mortality (P = 0.690).
TIPS was safe and effective in decreasing portal vein pressure and rebleeding rate in patients with CPVT.
关于慢性门静脉血栓形成（CPVT）患者治疗的研究仍然有限，尤其是在不同类型的 CPVT 中。本研究旨在评估经颈静脉肝内门体分流术（TIPS）在所有类型 CPVT 合并静脉曲张出血患者中的疗效。
2011 年 1 月至 2019 年 6 月期间接受 TIPS 治疗的 CPVT 患者根据血栓形成程度分为四型。所有患者均有静脉曲张出血史。收集并记录患者的特征和临床参数。分析手术成功率、门静脉压力变化、再出血、肝性脑病（HE）、支架狭窄和总体死亡率等数据。
本研究共纳入 189 例患者（1 型 39 例，2 型 84 例，3 型 48 例，4 型 18 例）。TIPS 手术成功率为 86.2%。四型间成功率差异有统计学意义（89.7%比 88.1%比 83.3%比 77.8%，P=0.001）。在 TIPS 成功组中，门静脉压力从 27.15±6.59mmHg 显著降低至 19.74±6.73mmHg（P<0.001），且再出血率明显低于失败组（14.7%比 30.8%，P=0.017）。此外，两组间 HE 发生率（30.7%比 26.9%，P=0.912）或总体死亡率（12.9%比 19.2%，P=0.403）差异均无统计学意义。在 TIPS 成功组中，我们发现 HE 的发生在四型间差异有统计学意义（P=0.020），而再出血率（P=0.669）、支架狭窄率（P=0.056）或总体死亡率（P=0.690）差异均无统计学意义。
TIPS 安全有效，可降低 CPVT 患者的门静脉压力和再出血率。
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