The clinical efficacy of transjugular intrahepatic portosystemic shunt combined with gastric coronary vein embolization for the treatment of liver cirrhosis with gastroesophageal varices hemorrhage_West China Medical Journal

Authors：

YAO Yong ,  ZHANG Chunle , XU Jianyu , LIU Tianyu , LIU Jie , XIE Lan

Department of Gastroenterology, Suining Central Hospital, Suining, Sichuan 629000, P. R. China;

Corresponding author：

ZHANG Chunle, Email: sugar139000@163.com

Keywords：

Liver cirrhosis; Transjugular intrahepatic portosystemic shunt; Gastric coronary vein embolization; Hepatic encephalopathy; Stent stenosis

DOI：

10.7507/1002-0179.201605094

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Objective To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with gastric coronary vein embolization for the treatment of liver cirrhosis with gastroesophageal varices hemorrhage, and evaluate its application value. Methods The data of 50 patients with liver cirrhosis who were treated with TIPS combined with gastric coronary vein embolization between June 2009 and January 2013 were retrospectively analyzed. According to Child-Pugh Liver Grade, the patients were divided into grade A liver function group (n=6), grade B liver function group (n=18), and grade C liver function group (n=26); according to the type of stent implantation, the patients were divided into covered stent group (n=29) and bare stent group (n=21). The 1-week and 1-, 3-, 6-, and 12-month postoperative liver function changes were compared, and the 2-year postoperative rebleeding rate, survival rate, stent restenosis rate, and hepatic encephalopathy incidence were observed. Results The success rate of surgery was 100.0% (50/50), and the success rate of emergency surgery was 100.0% (3/3) in 3 patients with active bleeding. The portal vein pressure decreased from (39.46±2.82) cm H₂O (1 cm H₂O=0.098 kPa) before the surgery to (25.62±2.13) cm H₂O after the surgery, and the difference was statistically significant (P<0.05). In grade A and grade B liver function groups, and covered stent and bare stent groups, the differences between preoperative and postoperative liver function indexes were not statistically significant (P>0.05); in grade C liver function group, the 1-week, 1-month, 3-month postoperative values of alanine aminotransferase, aspartate aminotransferase, total bilirubin and direct bilirubin increased compared with the preoperative values, and the differences were statistically significant (P<0.05). The postoperative 2-year rebleeding rate was 12.0% (6/50), and the postoperative 2-year incidence of hepatic encephalopathy was 16.0% (8/50). The postoperative 2-year stent stenosis rate was 26.0% (13/50) in the 50 cases, which was 13.8% (4/29) in covered stent group and 42.9% (9/21) in bare stent group, respectively. The postoperative 2-year survival rate was 90.0% (45/50). Conclusions TIPS combined with gastric coronary vein embolization in the treatment of liver cirrhosis with gastroesophageal varices bleeding has the exact effect, low rebleeding rate, fewer complications, and can be repeated. The preoperative evaluation of patients’ liver function, the application of stent of diameter 8 mm, paying attention to the perioperative period and regular follow-up treatment are helpful to reduce or prevent the occurrence of hepatic encephalopathy, stent stenosis and other complications.

Citation： YAO Yong, ZHANG Chunle, XU Jianyu, LIU Tianyu, LIU Jie, XIE Lan. The clinical efficacy of transjugular intrahepatic portosystemic shunt combined with gastric coronary vein embolization for the treatment of liver cirrhosis with gastroesophageal varices hemorrhage. West China Medical Journal, 2017, 32(8): 1173-1178. doi: 10.7507/1002-0179.201605094 Copy

1.	中华医学会消化病学分会消化介入学组. 经颈静脉肝内门体静脉分流术治疗肝硬化门静脉高压共识意见. 临床肝胆病杂志, 2014, 30(3): 210-213.
2.	李灵敏, 肖天利, 陈文生. MELD 与 CTP 评分系统对 TIPS 术后患者预后的评价作用. 第三军医大学学报, 2009, 31(8): 733-736.
3.	Loffroy R, Estivalet L, Cherblanc V, et al. Transjugular intrahepatic portosystemic shunt for the management of acute variceal hemorrhage. World J Gastroenterol, 2013, 19(37): 6131-6143.
4.	Krajina A, Hulek P, Fejfar T, et al. Quality improvement guidelines for transjugular intrahepatic portosystemic shunt (TIPS). Cardiovasc Intervent Radiol, 2012, 35(6): 1295-1300.
5.	García-Pagán JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med, 2010, 362(25): 2370-2379.
6.	Chen S, Li X, Wei B, et al. Recurrent variceal bleeding and shunt patency: prospective randomized controlled trial of transjugular intrahepatic portosystemic shunt alone or combined with coronary vein embolization. Radiology, 2013, 268(3): 900-906.
7.	魏波, 陈爽, 李肖, 等. 经颈静脉肝内门体分流术联合胃冠状静脉栓塞术降低曲张静脉再出血率的研究. 中华肝脏病杂志, 2011, 19(7): 494-497.
8.	何创业, 祁兴顺, 帖君, 等. 经颈内静脉肝内门体分流术联合封堵器封堵治疗肝硬化门脉高压伴自发性脾、胃-肾分流. 介入放射学杂志, 2013, 22(10): 801-805.
9.	Pomier-Layrargues G, Bouchard L, Lafortune M, et al. The transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension: current status. Int J Hepatol, 2012, 1: 167868.
10.	蔡炜, 诸葛宇征, 仇毓东, 等. 经颈静脉肝内门体分流术后分流道失功和肝性脑病发生的危险因素及预防对策. 中华消化外科杂志, 2013, 12(11): 850-854.
11.	Bai M, Qi X, Yang Z, et al. Predictors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in cirrhotic patients: a systematic review. J Gastroenterol Hepatol, 2011, 26(6): 943-951.
12.	Gluud LL, Dam G, Borre M, et al. Lactulose, rifaximin or branched chain amino acids for hepatic encephalopathy: what is the evidence? Metab Brain Dis, 2013, 28(2, SI): 221-225.
13.	Narahara Y, Kanazawa H, Fukuda T, et al. Transjugular intrahepatic portosystemic shunt versus paracentesis plus albumin in patients with refractory ascites who have good hepatic and renal function: a prospective randomized trial. J Gastroenterol, 2011, 46(1): 78-85.
14.	Perarnau JM, Le Gouge A, Nicolas C, et al. Covered vs. uncovered stents for transjugular intrahepatic portosystemic shunt: a randomized controlled trial. J Hepatol, 2014, 60(5): 962-968.
15.	梁艳平, 唐映梅, 杨晋辉, 等. TIPS 术后支架功能障碍的研究现状. 世界华人消化杂志, 2013, 21(4): 336-340.
16.	李松蔚, 李迎春, 闫东, 等. Fluency 覆膜支架行 TIPS 术后支架狭窄原因分析. 介入放射学杂志, 2015, 24(12): 1047-1051.
17.	Mcnaughton DA, Abu-Yousef MM. Doppler US of the liver made simple. Radiographics, 2011, 31(1): 161-188.

1. 中华医学会消化病学分会消化介入学组. 经颈静脉肝内门体静脉分流术治疗肝硬化门静脉高压共识意见. 临床肝胆病杂志, 2014, 30(3): 210-213.
2. 李灵敏, 肖天利, 陈文生. MELD 与 CTP 评分系统对 TIPS 术后患者预后的评价作用. 第三军医大学学报, 2009, 31(8): 733-736.
3. Loffroy R, Estivalet L, Cherblanc V, et al. Transjugular intrahepatic portosystemic shunt for the management of acute variceal hemorrhage. World J Gastroenterol, 2013, 19(37): 6131-6143.
4. Krajina A, Hulek P, Fejfar T, et al. Quality improvement guidelines for transjugular intrahepatic portosystemic shunt (TIPS). Cardiovasc Intervent Radiol, 2012, 35(6): 1295-1300.
5. García-Pagán JC, Caca K, Bureau C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med, 2010, 362(25): 2370-2379.
6. Chen S, Li X, Wei B, et al. Recurrent variceal bleeding and shunt patency: prospective randomized controlled trial of transjugular intrahepatic portosystemic shunt alone or combined with coronary vein embolization. Radiology, 2013, 268(3): 900-906.
7. 魏波, 陈爽, 李肖, 等. 经颈静脉肝内门体分流术联合胃冠状静脉栓塞术降低曲张静脉再出血率的研究. 中华肝脏病杂志, 2011, 19(7): 494-497.
8. 何创业, 祁兴顺, 帖君, 等. 经颈内静脉肝内门体分流术联合封堵器封堵治疗肝硬化门脉高压伴自发性脾、胃-肾分流. 介入放射学杂志, 2013, 22(10): 801-805.
9. Pomier-Layrargues G, Bouchard L, Lafortune M, et al. The transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension: current status. Int J Hepatol, 2012, 1: 167868.
10. 蔡炜, 诸葛宇征, 仇毓东, 等. 经颈静脉肝内门体分流术后分流道失功和肝性脑病发生的危险因素及预防对策. 中华消化外科杂志, 2013, 12(11): 850-854.
11. Bai M, Qi X, Yang Z, et al. Predictors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in cirrhotic patients: a systematic review. J Gastroenterol Hepatol, 2011, 26(6): 943-951.
12. Gluud LL, Dam G, Borre M, et al. Lactulose, rifaximin or branched chain amino acids for hepatic encephalopathy: what is the evidence? Metab Brain Dis, 2013, 28(2, SI): 221-225.
13. Narahara Y, Kanazawa H, Fukuda T, et al. Transjugular intrahepatic portosystemic shunt versus paracentesis plus albumin in patients with refractory ascites who have good hepatic and renal function: a prospective randomized trial. J Gastroenterol, 2011, 46(1): 78-85.
14. Perarnau JM, Le Gouge A, Nicolas C, et al. Covered vs. uncovered stents for transjugular intrahepatic portosystemic shunt: a randomized controlled trial. J Hepatol, 2014, 60(5): 962-968.
15. 梁艳平, 唐映梅, 杨晋辉, 等. TIPS 术后支架功能障碍的研究现状. 世界华人消化杂志, 2013, 21(4): 336-340.
16. 李松蔚, 李迎春, 闫东, 等. Fluency 覆膜支架行 TIPS 术后支架狭窄原因分析. 介入放射学杂志, 2015, 24(12): 1047-1051.
17. Mcnaughton DA, Abu-Yousef MM. Doppler US of the liver made simple. Radiographics, 2011, 31(1): 161-188.

West China Medical Journal

The clinical efficacy of transjugular intrahepatic portosystemic shunt combined with gastric coronary vein embolization for the treatment of liver cirrhosis with gastroesophageal varices hemorrhage

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