Zhou Yongjie, Ma Jingqin, Liu Yaozu, Ma Li, Yu Jiaze, Yang Minjie, Yan Zhiping, Zhang Wen, Luo Jianjun
Department of Interventional Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.
Shanghai Institution of Medical Imaging, Shanghai, China.
Hepatol Int. 2025 Sep 18. doi: 10.1007/s12072-025-10908-1.
The effect of shunting the left or right branch of the portal vein on the post-transjugular intrahepatic portosystemic shunt (TIPS) hepatic encephalopathy (HE) remains controversial. Therefore, we designed this prospective, randomized, single-blinded trial to compare the incidence of HE after shunting the left or right branch of the portal vein during TIPS in cirrhotic patients to prevent variceal rebleeding.
Consecutive patients diagnosed with hepatitis B virus (HBV)-related cirrhosis were randomly assigned in a 1:1 ratio to undergo the TIPS procedure, with the shunt directed to either the left or right branch of the portal vein. The primary outcome was the incidence of overt HE within 2 years. The secondary outcomes included shunt dysfunction, variceal rebleeding, survival, adverse events, and changes in liver function.
Between June 2019 and December 2020, 130 patients were randomly divided into two groups (left branch group vs right branch group). The 2-year cumulative incidence rates of free overt HE in the left branch group did not demonstrate statistical superiority over the right branch group (78.5% vs 68.6%, respectively; p = 0.236, HR = 1.49, 95% CI 0.76-2.93). Similarly, no statistical differences were observed in stent patency, all-cause bleeding, survival, or adverse events.
Compared to shunting the right branch of the portal vein, shunting the left branch during TIPS placement did not impact the incidence of post-TIPS HE and other clinical outcomes in cirrhotic patients to prevent variceal rebleeding. The choice of puncture site should be primarily guided by the patient's liver anatomy and the operator's experience.
门静脉左支或右支分流对经颈静脉肝内门体分流术（TIPS）后肝性脑病（HE）的影响仍存在争议。因此，我们设计了这项前瞻性、随机、单盲试验，以比较肝硬化患者在TIPS期间门静脉左支或右支分流后HE的发生率，以预防静脉曲张再出血。
连续诊断为乙型肝炎病毒（HBV）相关肝硬化的患者按1:1比例随机分配接受TIPS手术，分流至门静脉的左支或右支。主要结局是2年内显性HE的发生率。次要结局包括分流功能障碍、静脉曲张再出血、生存率、不良事件和肝功能变化。
2019年6月至2020年12月期间，130例患者被随机分为两组（左支组与右支组）。左支组2年累积显性HE发生率在统计学上并不优于右支组（分别为78.5%和68.6%；p = 0.236，HR = 1.49，95%CI 0.76 - 2.93）。同样，在支架通畅率、全因出血、生存率或不良事件方面未观察到统计学差异。
与门静脉右支分流相比，在TIPS放置期间左支分流对肝硬化患者预防静脉曲张再出血的TIPS术后HE发生率和其他临床结局没有影响。穿刺部位的选择应主要根据患者的肝脏解剖结构和操作者的经验来指导。
