Transjugular intrahepatic portosystemic shunt and splenectomy are more effective than endoscopic therapy for recurrent variceal bleeding in patients with idiopathic noncirrhotic portal hypertension  

作　　者：Fu-Liang He Rui-Zhao Qi Yue-Ning Zhang Ke Zhang Yu-Zheng Zhu-Ge Min Wang Yu Wang Ji-Dong Jia Fu-Quan Liu 

机构地区：[1]Department of Hepatology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China [2]Department of General Surgery,Fifth Medical Center of PLA General Hospital,Beijing 100039,China [3]Department of Gastroenterology,Beijing You’an Hospital,Capital Medical University,Beijing 100069,China [4]Department of General Surgery,Beijing Ditan Hospital,Capital Medical University,Beijing 100102,China [5]Department of Gastroenterology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu Province,China [6]Department of Interventional Therapy,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China

出　　处：《World Journal of Clinical Cases》2020年第10期1871-1877,共7页世界临床病例杂志

基　　金：Supported by Beijing Hospitals Authority Youth Program,No.20180701.

摘　　要：BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS),splenectomy plus esophagogastric devascularization(SED)and endoscopic therapy+non-selectiveβ-blockers(ET+NSBB)are widely applied in secondary prevention of recurrent gastroesophageal variceal bleeding in patients with liver cirrhosis.These different treatments,however,have not been compared in patients with idiopathic noncirrhotic portal hypertension(INCPH).AIM To compare the outcomes of TIPS,SED and ET+NSBB in the control of variceal rebleeding in patients with INCPH.METHODS This retrospective study recruited patients from six centers across China.Demographic characteristics,baseline profiles and follow-up clinical outcomes were collected.Post-procedural clinical outcomes,including incidence of rebleeding,hepatic encephalopathy(HE),portal vein thrombosis(PVT)and mortality rates,were compared in the different groups.RESULTS In total,81 patients were recruited,with 28 receiving TIPS,26 SED,and 27 ET+NSBB.No significant differences in demographic and baseline characteristics were found among these three groups before the procedures.After treatment,blood ammonia was significantly higher in the TIPS group;hemoglobin level and platelet count were significantly higher in the SED group(P<0.01).Rebleeding rate was significantly higher in the ET+NSBB group(P<0.01).Mortality was 3.6%,3.8%and 14.8%in the TIPS,SED and ET+NSBB groups,respectively,with no significant differences(P=0.082).Logistic regression analysis showed that mortality was significantly correlated with rebleeding,HE,portal thrombosis and superior mesenteric vein thrombosis(P<0.05).CONCLUSION In patients with INCPH,TIPS and SED were more effective in controlling rebleeding than ET+NSBB,but survival rates were not significantly different among the three groups.Mortality was significantly correlated with rebleeding,HE and PVT.

关 键 词：Idiopathic non-cirrhotic portal hypertension Transjugular intrahepatic portosystemic shunt Splenectomy plus esophagogastric devascularization Endoscopic therapy SURVIVAL 

分 类 号：R657.3[医药卫生—外科学]