Evaluation of the Efficacy and Safety of Transjugular Intrahepatic Portosystemic Shunt Combined With Concurrent Antegrade Embolization of Large Spontaneous Portosystemic Shunts

IF 2.2 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Medical Imaging and Radiation Oncology Pub Date : 2025-02-21 DOI:10.1111/1754-9485.13832

Ze Wang, Xiao-Yang Xu, Chen-You Liu, Jin-Tao Huang, Wan-Ci Li, Shuai Zhang, Jian Shen, Bin-Yan Zhong, Xiao-Li Zhu

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Abstract

Objectives

To compare the long-term efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with concurrent antegrade embolization in treating portal hypertension with oesophagogastric variceal bleeding in patients with and without large spontaneous portosystemic shunts (L-SPSSs).

Materials and Methods

We retrospectively analysed data from patients with portal hypertension who underwent TIPS from November 2015 to April 2022. The patients were screened according to the inclusion criteria and were divided into L-SPSSs group (L-S group) and Non L-SPSSs group (Non L-S group). The primary outcome was the 2-year liver transplantation-free survival (TFS) rate. Secondary outcomes contained the incidence of overt hepatic encephalopathy (OHE), ectopic embolization and the 2-year rebleeding rate.

Results

A total of 259 patients were enrolled (64 patients in L-S group and 195 patients in Non L-S group). The average age was 57.2 years, and the success rate of procedure was 100%. Baseline data showed no significant differences between two groups. There was a statistically significant difference in the 2-year liver transplantation-free rate between two groups (L-S vs. Non L-S, 84.38% vs. 71.28%; p = 0.045). OHE occurred in 19 (29.69%) patients with L-SPSSs and 104 (53.33%) patients without L-SPSSs, with a statistically significant difference (p = 0.001). And no statistically significant difference was found in ectopic embolism incidence rate and the 2-year rebleeding rate between two groups. Multivariate Cox regression analysis identified male gender, portal vein thrombosis and preoperative high blood ammonia levels as independent risk factors for long-term survival.

Conclusion

Compared to Non L-S group, the patients in L-S group achieve longer liver transplantation-free survival and lower incidence rate of OHE without increasing the risk of 2-year rebleeding and ectopic embolization.

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经颈静脉肝内门静脉系统分流联合并发顺行栓塞治疗大型自发性门静脉系统分流的疗效和安全性评价。

目的：比较经颈静脉肝内门静脉系统分流术（TIPS）联合并发顺行栓塞治疗有或无大自发性门静脉系统分流术（l - sps）的门脉高压合并食管胃静脉曲张出血的长期疗效和安全性。材料和方法：我们回顾性分析了2015年11月至2022年4月期间接受TIPS治疗的门静脉高压症患者的资料。根据纳入标准筛选患者，分为l - spss组（L-S组）和Non - spss组（Non - L-S组）。主要终点是2年无肝移植生存率（TFS）。次要结果包括显性肝性脑病（OHE）的发生率、异位栓塞和2年再出血率。结果：共纳入259例患者（L-S组64例，Non - L-S组195例）。平均年龄57.2岁，手术成功率100%。基线数据显示两组间无显著差异。两组患者2年无肝移植率差异有统计学意义(L-S组vs. Non - L-S组，84.38% vs. 71.28%；p = 0.045)。l - spss患者发生OHE 19例（29.69%），无l - spss患者发生OHE 104例（53.33%），差异有统计学意义（p = 0.001）。两组患者异位栓塞发生率及2年再出血率差异无统计学意义。多因素Cox回归分析发现，男性、门静脉血栓形成和术前高血氨水平是影响长期生存的独立危险因素。结论：与非L-S组相比，L-S组患者无肝移植生存期更长，OHE发生率更低，且未增加2年再出血和异位栓塞的风险。

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来源期刊

Journal of Medical Imaging and Radiation Oncology 医学-核医学

CiteScore

3.30

自引率

6.20%

发文量

133

审稿时长

6-12 weeks

期刊介绍： Journal of Medical Imaging and Radiation Oncology (formerly Australasian Radiology) is the official journal of The Royal Australian and New Zealand College of Radiologists, publishing articles of scientific excellence in radiology and radiation oncology. Manuscripts are judged on the basis of their contribution of original data and ideas or interpretation. All articles are peer reviewed.