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.	中華醫學會消化病學分會消化介入學組. 經頸靜脈肝內門體靜脈分流術治療肝硬化門靜脈高壓共識意見. 臨床肝膽病雜志, 2014, 30(3): 210-213.
2.	李靈敏, 肖天利, 陳文生. MELD 與 CTP 評分系統對 TIPS 術后患者預后的評價作用. 第三軍醫大學學報, 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, 陳爽, 李肖, 等. 經頸靜脈肝內門體分流術聯合胃冠狀靜脈栓塞術降低曲張靜脈再出血率的研究. 中華肝臟病雜志, 2011, 19(7): 494-497.
8.	何創業, 祁興順, 帖君, 等. 經頸內靜脈肝內門體分流術聯合封堵器封堵治療肝硬化門脈高壓伴自發性脾、胃-腎分流. 介入放射學雜志, 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.	蔡煒, 諸葛宇征, 仇毓東, 等. 經頸靜脈肝內門體分流術后分流道失功和肝性腦病發生的危險因素及預防對策. 中華消化外科雜志, 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.	梁艷平, 唐映梅, 楊晉輝, 等. TIPS 術后支架功能障礙的研究現狀. 世界華人消化雜志, 2013, 21(4): 336-340.
16.	李松蔚, 李迎春, 閆東, 等. Fluency 覆膜支架行 TIPS 術后支架狹窄原因分析. 介入放射學雜志, 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. 中華醫學會消化病學分會消化介入學組. 經頸靜脈肝內門體靜脈分流術治療肝硬化門靜脈高壓共識意見. 臨床肝膽病雜志, 2014, 30(3): 210-213.
2. 李靈敏, 肖天利, 陳文生. MELD 與 CTP 評分系統對 TIPS 術后患者預后的評價作用. 第三軍醫大學學報, 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, 陳爽, 李肖, 等. 經頸靜脈肝內門體分流術聯合胃冠狀靜脈栓塞術降低曲張靜脈再出血率的研究. 中華肝臟病雜志, 2011, 19(7): 494-497.
8. 何創業, 祁興順, 帖君, 等. 經頸內靜脈肝內門體分流術聯合封堵器封堵治療肝硬化門脈高壓伴自發性脾、胃-腎分流. 介入放射學雜志, 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. 蔡煒, 諸葛宇征, 仇毓東, 等. 經頸靜脈肝內門體分流術后分流道失功和肝性腦病發生的危險因素及預防對策. 中華消化外科雜志, 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. 梁艷平, 唐映梅, 楊晉輝, 等. TIPS 術后支架功能障礙的研究現狀. 世界華人消化雜志, 2013, 21(4): 336-340.
16. 李松蔚, 李迎春, 閆東, 等. Fluency 覆膜支架行 TIPS 術后支架狹窄原因分析. 介入放射學雜志, 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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