Outcomes of Transjugular Intrahepatic Portosystemic Shunt and Gastric Coronary Vein Embolization for Variceal Bleeding in Cirrhotic Portal Hypertension.

IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL
Gauri Mukhiya, Xinwei Han, Dechao Jiao, Yonghua Bi, Gaurab Pokhrel, Zaoqu Liu, Zhaonan Li, Yongfu He
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引用次数: 0

Abstract

Purpose: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with gastric coronary vein embolization (GCVE) for cirrhotic portal hypertensive variceal bleeding and compare outcomes of first-line with second-line treatment, coil with glue, and single-covered with double stents.Methods: Fifteen patients received TIPS plus GCVE as the first-line treatment for secondary prophylaxis of variceal bleeding, and 45 received it as second-line treatment. Preoperative and postoperative quantitative variables were compared using a paired t test. The incidence of survival rate, re-bleeding, hepatic encephalopathy, and shunt dysfunction were analyzed using the Kaplan-Meier method.Results: The portal venous pressure was significantly decreased from 39.0 ± 5.0 mm Hg to 22.5 ± 4.4 mm Hg (P≤0.001) after TIPS treatment. After 1, 3, 6, 12, 18, and 24 months re-bleeding rates were 1.6%, 3.3%, 6.6%, 13.3%, 0%, and 0%, respectively. Shunt dysfunction rates were 5%, 0%, 10%, 16.6%, 1.6%, and 5%, respectively. Hepatic encephalopathy rates were 3.3%, 1.6%, 3.3%, 6.6%, 0%, and 0%, respectively. And survival rates were 100%, 100%, 100%, 96.6%, 93.3%, and 88.3% respectively. In comparative analysis, statistically significant differences were seen in re-bleeding between the first-line and second-line treatment groups (26.6% vs 24.4%, log-rank P=0.012), and survival rates between single-covered and double stent (3.7% vs 16.1%, log-rang (P=0.043).Conclusion: The results suggest that TIPS combined with GCVE is effective and safer in the treatment of cirrhotic portal hypertensive variceal bleeding. The use of TIP plus GCVE as first-line treatment, may be preferable for high-risk re-bleeding, and more than 25 mm Hg portal venous pressure with repeated variceal bleeding. However, the sample size was small. Therefore, large, randomized, controlled, multidisciplinary center studies are needed for further evaluation.

经颈静脉肝内门静脉系统分流术和胃冠状静脉栓塞治疗肝硬化门静脉高压症静脉曲张出血的疗效。
目的:评价经颈静脉肝内门静脉系统分流术(TIPS)联合胃冠状静脉栓塞术(GCVE)治疗肝硬化门脉高压静脉曲张出血的疗效和安全性,并比较一线治疗与二线治疗、胶圈治疗和单覆盖双支架治疗的疗效。方法:15例患者采用TIPS联合GCVE作为静脉曲张出血二级预防的一线治疗方案,45例患者采用TIPS联合GCVE作为二级预防治疗方案。术前和术后定量变量采用配对t检验进行比较。采用Kaplan-Meier法分析生存率、再出血、肝性脑病和分流功能障碍的发生率。结果:TIPS治疗后门静脉压由39.0±5.0 mm Hg降至22.5±4.4 mm Hg (P≤0.001)。术后1、3、6、12、18、24个月再出血率分别为1.6%、3.3%、6.6%、13.3%、0%、0%。分流功能障碍发生率分别为5%、0%、10%、16.6%、1.6%和5%。肝性脑病发生率分别为3.3%、1.6%、3.3%、6.6%、0%和0%。生存率分别为100%、100%、100%、96.6%、93.3%、88.3%。在比较分析中,一线和二线治疗组再出血发生率(26.6% vs 24.4%, log-rank P=0.012),单支架和双支架生存率(3.7% vs 16.1%, log-rank P=0.043)差异有统计学意义。结论:TIPS联合GCVE治疗肝硬化门脉高压静脉曲张出血有效且安全。TIP联合GCVE作为一线治疗,对于高危再出血、门静脉压大于25mm Hg并反复静脉曲张出血的患者可能更可取。然而,样本量很小。因此,需要大规模、随机、对照、多学科的中心研究来进一步评估。
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来源期刊
Clinical Medicine & Research
Clinical Medicine & Research MEDICINE, GENERAL & INTERNAL-
CiteScore
1.80
自引率
7.10%
发文量
25
期刊介绍: Clinical Medicine & Research is a peer reviewed publication of original scientific medical research that is relevant to a broad audience of medical researchers and healthcare professionals. Articles are published quarterly in the following topics: -Medicine -Clinical Research -Evidence-based Medicine -Preventive Medicine -Translational Medicine -Rural Health -Case Reports -Epidemiology -Basic science -History of Medicine -The Art of Medicine -Non-Clinical Aspects of Medicine & Science
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