Association between portal vein pressure drop gradient after transjugular intrahepatic portosystemic shunt and clinical prognosis

• Main Authors: XU Zhengguo, ZHAO Yongbing, ZHENG Yuanyu
• Format: Article
• Language: zho
• Published: Editorial Department of Journal of Clinical Hepatology 2016-12-01
• Series: Linchuang Gandanbing Zazhi
• Online Access: http://www.lcgdbzz.org/qk_content.asp?id=7879

ObjectiveTo investigate the association between portal vein pressure drop gradient in patients with cirrhotic portal hypertension treated by transjugular intrahepatic portosystemic shunt (TIPS) and clinical prognosis, as well as the ideal range of portal vein pressure drop. MethodsA total of 58 patients who underwent TIPS in Xinqiao Hospital of Third Military Medical University from November 2013 to December 2015 were enrolled. All the patients underwent TIPS and embolization of the gastric coronary vein and the short gastric veins, and the change intervals of portal vein pressure gradient were monitored. The follow-up time ranged from 3 days to 2 years, and the association of portal vein pressure drop gradient with postoperative liver function, splenic function, rebleeding rate, hepatic encephalopathy, and portal hypertensive gastrointestinal diseases was analyzed. The paired t-test was used for comparison of parameters before and after treatment. ResultsThe patients had a significant reduction in liver function on day 3 after surgery. At 2 month after surgery, the levels of TBil was rised and had significant changes［(49.81±27.82)μmol/L vs (31.64±17.67) μmol/L,t=5.372,P＜0.001］. At 6 months after surgery, red blood cell count and platelet count had no significant changes，but，white blood cell count was reduced［(3.79±1.37）×109/L vs (4.57±2.24)×109/L，t=2.835，P=0.006］. There was a 23% reduction in portal vein pressure after surgery (from 30.62±3.56 mmHg before surgery to 21.21±2.90 mmHg after surgery, t=23.318，P＜0.001). All the patients had varying degrees of relief of gastrointestinal symptoms associated with portal vein hypertension, such as abdominal distension, poor appetite, and diarrhea. Of all patients, none experienced in-stent restenosis or occlusion and 13 experienced hepatic encephalopathy after surgery, which tended to occur at the time when postoperative portal vein pressure was reduced to 14.7-25.7 mmHg, i.e., a 36%-40% reduction in portal vein pressure. The results of splenic venography performed immediately after surgery showed that varicose veins almost disappeared and that there were no collateral varices. Gastroscopy was performed again within 1 month after surgery and 5 patients had no significant changes in esophageal varices. The other patients were followed up for 2 years, and the severity of esophageal and gastric varices gradually changed from severe varices with red color sign to moderate and mild varices and even disappeared. The proportion of patients with mild and disappeared varices increased from 22% on day 3 after surgery to 52% in the second year after surgery. No patients experienced rebleeding within 1 month after surgery. Six patients each experienced rebleeding at 2, 6, 10, 14, 16, and 24 months after surgery, and in one patient, duodenal bulbar ulcer and bleeding was not excluded; the other 5 patients experienced gastric variceal bleeding again, with a median portal vein pressure of 36.46 mmHg before surgery and 24.8 mmHg after surgery, with a 32% reduction in portal vein pressure. ConclusionTIPS has a good clinical effect in hemostasis and prevention of rebleeding in patients with cirrhotic portal hypertension and can control the portal vein pressure below 21.21±2.90 mmHg, and the degree of reduction in portal vein pressure is below 36%-40%. It can reduce the incidence of postoperative rebleeding and avoid the development of hepatic encephalopathy. TIPS can cause liver impairment within a short period of time after surgery, and liver function can return to normal within 1-6 months after surgery, but splenic function does not recover significantly.