Prognosis after splenectomy plus pericardial devascularization vs transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding  

作　　者：Wei-Li Qi Jun Wen Tian-Fu Wen Wei Peng Xiao-Yun Zhang Jun-Yi Shen Xiao Li Chuan Li 

机构地区：[1]Department of Liver Surgery,West China Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China [2]Section for HepatoPancreatoBiliary Surgery,Department of General Surgery,The Third People’s Hospital of Chengdu,Affiliated Hospital of Southwest Jiaotong University&The Second Affiliated Hospital of Chengdu,Chongqing Medical University,Chengdu 610041,Sichuan Province,China [3]Department of Interventional Therapy,West China Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China [4]Department of Interventional Therapy,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100000,China

出　　处：《World Journal of Gastrointestinal Surgery》2023年第8期1641-1651,共11页世界胃肠外科杂志（英文版）（电子版）

基　　金：the National Key R&D Program of China,No.2022YFC2503701;the Science and Technological Supports Project of Sichuan Province,No.2022YFS0255;the National Natural Science Foundation of China,No.81800449.

摘　　要：BACKGROUND Portal hypertension combined with esophagogastric variceal bleeding(EGVB)is a serious complication in patients with hepatitis B virus(HBV)-related cirrhosis in China.Splenectomy plus pericardial devascularization(SPD)and transjugular intrahepatic portosystemic shunt(TIPS)are effective treatments for EGVB.However,a comparison of the effectiveness and safety of those methods is lacking.AIM To compare the prognosis after SPD vs TIPS for acute EGVB after failure of endoscopic therapy or secondary prophylaxis of variceal rebleeding(VRB)in patients with HBV-related cirrhosis combined with portal hypertension.METHODS This retrospective cohort study included 318 patients with HBV-related cirrhosis and EGVB who underwent SPD or TIPS at West China Hospital of Sichuan University during 2009-2013.Propensity score-matched analysis(PSM),the Kaplan-Meier method,and multivariate Cox regression analysis were used to compare overall survival,VRB rate,liver function abnormality rate,and hepatocellular carcinoma(HCC)incidence between the two patient groups.RESULTS The median age was 45.0 years(n=318;226(71.1%)males).During a median follow-up duration of 43.0 mo,18(11.1%)and 33(21.2%)patients died in the SPD and TIPS groups,respectively.After PSM,SPD was significantly associated with better overall survival(OS)(P=0.01),lower rates of abnormal liver function(P<0.001),and a lower incidence of HCC(P=0.02)than TIPS.The VRB rate did not differ significantly between the two groups(P=0.09).CONCLUSION Compared with TIPS,SPD is associated with higher postoperative OS rates,lower rates of abnormal liver function and HCC,and better quality of survival as acute EGVB treatment after failed endoscopic therapy or as secondary prophylaxis of VRB in patients with HBV-related cirrhosis combined with portal hypertension.There is no significant between-group difference in VRB rates.

关 键 词：Portal hypertension Liver cirrhosis Esophagogastric variceal bleeding SPLENECTOMY Pericardial devascularization Transjugular intrahepatic portosystemic shunt 

分 类 号：R575.2[医药卫生—消化系统] R735.7[医药卫生—内科学]