Transjugular intrahepatic portosystemic shunt for variceal rebleeding after splenectomy

doi:10.3877/cma.j.issn.2095-5782.2020.02.003

Abstract

Abstract:

Objective

To evaluate the feasibility and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for variceal rebleeding after splenectomy.

Methods

33 patients with variceal rebleeding after splenectomy underwent TIPS in our hospitalfrom December 2010 to December 2016 were enrolled in this retrospective study. Success rates, efficacy, and complications were evaluated.

Results

TIPS was successfully performed in 31 patients and failed in 2. Mean portosystemic pressure gradient (PPG) fell from 23.5±5.9 mmHg to 12.1±3.3 mmHg after successful TIPS procedure (P<0.05). One patient died due to septic shock during perioperative period. The median follow-up of 62.5 months in 30 cases. Shunt dysfunction appeared in 10 cases with4 rebleeding and 1 of them died due to rebleeding, while 1 case suffered massive ascites and 1 case suffered acute mesenteric vein thrombosis followed by intestinal obstruction. Overt hepatic encephalopathy appeared in 10 cases. Four of them recovered after receiving medical treatment and 1 experienced grade 3 hepatic encephalopathy, while the other 5 died from liver failure due to severe cirrhosis. There were 2 more death due to pulmonary disease and 1 death due to hepatocellular carcinoma after procedure. The other patients remained asymptomatic and shunt patency. The average level of serum total bilirubin and serum albumin 6 months after procedure were better than those before procedure (P<0.05).

Conclusions

TIPS is safe and effective on controlling variceal rebleeding after splenectomy in portal hypertension.

Key words: Portal hypertension, Splenectomy, Portosystemic shunt

Junyang Luo, Ming'an Li, Mingsheng Huang, Zaibo Jiang. Transjugular intrahepatic portosystemic shunt for variceal rebleeding after splenectomy[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2020, 08(02): 114-119.

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References 18

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门静脉系统情况		例数（百分比）
门静脉肝内分支显影		33例（100%）
门静脉主干		?
?	通畅	3例（9.1%）
?	合并血栓	6例（18.2%）
?	完全闭塞合并粗大海绵样变	8例（24.2%）
?	完全闭塞合并纤细海绵样变	16例（48.5%）
胃左静脉数量		?
?	单支	23例（69.7%）
?	两支或以上	10例（30.3%）
胃左静脉开口部位		?
?	门静脉主干	29例（87.9%）
?	肠系膜上静脉	0
?	海绵样变侧支血管	1例（3.0%）
?	门静脉主干+肠系膜上静脉	3例（9.1%）
胃肾分流		0
腹腔动脉-门静脉瘘（脾动静脉瘘）		3例（9.1%）

门静脉系统情况		例数（百分比）
门静脉肝内分支显影		33例（100%）
门静脉主干		?
?	通畅	3例（9.1%）
?	合并血栓	6例（18.2%）
?	完全闭塞合并粗大海绵样变	8例（24.2%）
?	完全闭塞合并纤细海绵样变	16例（48.5%）
胃左静脉数量		?
?	单支	23例（69.7%）
?	两支或以上	10例（30.3%）
胃左静脉开口部位		?
?	门静脉主干	29例（87.9%）
?	肠系膜上静脉	0
?	海绵样变侧支血管	1例（3.0%）
?	门静脉主干+肠系膜上静脉	3例（9.1%）
胃肾分流		0
腹腔动脉-门静脉瘘（脾动静脉瘘）		3例（9.1%）

实验室指标	血清总胆红素（umol/L）	血清白蛋白（g/L）
术前（平均数±标准差）	31.8±22.2	31.3±4.7
术后（平均数±标准差）	23.7±9.7	33.8±3.2
P值	<0.05	<0.05

实验室指标	血清总胆红素（umol/L）	血清白蛋白（g/L）
术前（平均数±标准差）	31.8±22.2	31.3±4.7
术后（平均数±标准差）	23.7±9.7	33.8±3.2
P值	<0.05	<0.05

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