Department of Emergency Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science & Technology, Wuhan, 430022, Hubei, China.
Wisdom Lake Academy of Pharmacy, Xi'an Jiaotong-Liverpool University, Suzhou, 215123, Jiangsu, China.
Surg Endosc. 2024 Apr;38(4):2106-2115. doi: 10.1007/s00464-024-10729-7. Epub 2024 Mar 4.
This study aimed to compare postoperative complications in patients with esophagogastric variceal bleeding (EVB) who underwent laparoscopic splenectomy combined with pericardial devascularization (LSPD) versus transjugular intrahepatic portosystemic shunt (TIPS) procedures.
A retrospective collection of medical records was conducted from January 2014 to May 2020 at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. The study included patients from the departments of trauma surgery, interventional radiology, and general surgery who were diagnosed with EVB caused by portal hypertension and treated with LSPD or TIPS. Follow-up data were obtained to assess the occurrence of postoperative complications in both groups.
A total of 201 patients were included in the study, with 104 cases in the LSPD group and 97 cases in the TIPS group. There was no significant difference in the 1-year and 3-year post-surgery survival rates between the TIPS and LSPD groups (P = 0.669, 0.066). The 3-year survival rate of Child-Pugh B patients in the LSPD group was higher than TIPS group (P = 0.041). The LSPD group also had a significantly higher rate of freedom from rebleeding at 3-year post-surgery compared to the TIPS group (P = 0.038). Stratified analysis showed no statistically significant difference in the rebleeding rate between the two groups. Furthermore, the LSPD group had a higher rate of freedom from overt hepatic encephalopathy at 1-year and 3-year post-surgery compared to the TIPS group (P = 0.007, < 0.001). The LSPD group also had a lower rate of severe complications at 3-year post-surgery compared to the TIPS group (P = 0.020).
Compared to TIPS, LSPD does not increase the risk of mortality and rebleeding, while demonstrating fewer complications. In patients classified as Child-Pugh A and B, the use of LSPD for treating EVB is both safe and effective.
本研究旨在比较食管胃静脉曲张出血（EVB）患者行腹腔镜脾切除术联合贲门周围血管离断术（LSPD）与经颈静脉肝内门体分流术（TIPS）术后并发症。
回顾性收集 2014 年 1 月至 2020 年 5 月华中科技大学同济医学院附属协和医院创伤外科、介入放射科和普通外科收治的 EVB 患者的临床资料，患者均为门静脉高压引起的 EVB，行 LSPD 或 TIPS 治疗。获取随访资料评估两组术后并发症发生情况。
共纳入 201 例患者，LSPD 组 104 例，TIPS 组 97 例。TIPS 组和 LSPD 组 1 年和 3 年术后生存率差异无统计学意义（P=0.669，0.066）。LSPD 组 Child-Pugh B 级患者 3 年生存率高于 TIPS 组（P=0.041）。LSPD 组术后 3 年无再出血率明显高于 TIPS 组（P=0.038）。分层分析显示两组再出血率差异无统计学意义。此外，LSPD 组术后 1 年和 3 年无显性肝性脑病发生率明显高于 TIPS 组（P=0.007，<0.001）。LSPD 组术后 3 年严重并发症发生率低于 TIPS 组（P=0.020）。
与 TIPS 相比，LSPD 并不增加死亡率和再出血风险，且并发症更少。在 Child-Pugh A 和 B 级患者中，LSPD 治疗 EVB 安全有效。
