A clinical study of transjugular intrahepatic portosystemic shunt combined with stomach and esopha-geal variceal embolization for gastric varices bleeding / 中华消化内镜杂志

ABSTRACT

Objective To evaluate the clinical efficacy of transjugular intrahepatic portosystemic shunt(TIPS)combined with stomach and esophageal variceal embolization(SEVE)for gastric variceal haem-orrhage,and the efficacy with or without a gastrorenal shunt. Methods A total of 52 patients with gastric variceal bleeding history and portal hypertension treated with TIPS combined with SEVE were included from October 2013 to March 2015.Patients were divided into two groups according to preoperateive CT angiogra-phy,27 cases with gastric variceal haemorrhage associated with a gastrorenal shunt in group A,and 25 gastric varices bleeding cases without gastrorenal shunt in group B. During the follow-up,the incidence of the total rates of rebleeding,TIPS primary patency and hepatic encephalopathy,and the survival rates were compared between group A and group B. Results In all patients,the average portal vein pressure decreased from 36. 50±7. 00 cmH2 O(1 cmH2 O= 0. 098 kPa)before operation to 28. 15±6. 27 cmH2 O after TIPS combined with SEVE,with significant difference(t= 10. 357,P= 0. 001). Fifty two patients were followed up for 1 to 18 months(1-18 months in group A;1-15 months in group B).The total rates of rebleeding,TIPS primary patency,hepatic encephalopathy and survival were 11. 54%(6/ 52),86. 54%(45/ 52),11. 54%(6/ 52) and 92. 31%(48/ 52),respectively. There were no significant differences between the two groups in the total rates of rebleeding[11. 11%(3/ 27)VS 12. 00%(3/ 25),P = 1. 000],TIPS primary patency[88. 89%(24/ 27)VS 84. 00%(21/ 25),P= 1. 000],hepatic encephalopathy[14. 81%(4/ 27)VS 8. 00%(2/ 25), P= 0. 738]or total survival rate[92. 59%(25/ 27)VS 92. 00%(23/ 25),P = 1. 000]after TIPS combined with SEVE. Conclusion TIPS combined with SEVE is effective for gastric varices,and equally effective in the treatment of both gastric variceal haemorrhage associated with a gastrorenal shunt and gastric varices bleeding without gastrorenal shunt.