Effect of vascular disconnection combined with transjugular intrahepatic portosystemic shunt on portalblood flow and liver and kidney function in patients with portal hypertension and gastric esophageal varices

doi:10.3877/cma.j.issn.1674-0793.2019.06.007

Abstract

Abstract:

Objective

To analyze the effect of laparoscopic cardiopulmonary bypass and transjugular intrahepatic portosystemic shunt (TIPS) on cirrhotic portal hypertension.

Methods

Ninety-four patients with cirrhotic portal hypertension and gastric esophageal varices who were treated in the Second People’s Hospital of Yibin City from February 2016 to February 2018 were randomly divided into two groups. Patients in the control group (47 patients) underwent pericardial vascular separation, and patients in the observation group (47 cases) underwent TIPS on the basis of control group. The clinical efficacy, laboratory parameters and portal hemodynamics before and after operation were observed.

Results

(1) The total effective rate of the observation group was 95.74% (45/47), which was significantly higher than that of the control group (82.98%, 39/47), the difference was statistically significant (Z=5.173,P=0.005). (2) At 6 months after operation, splenic venous blood flow (SVF), portal pressure gradient, portal vein diameter (PVD), splenic vein diameter (SVD) and portal vein blood flow (PVF) of the observation group decreased compared with the preoperative level, and were significantly lower than the control group, while the splenic venous flow velocity (SVV) and portal venous flow velocity (PVV) were higher than the preoperative period, which were significantly higher than the same period, with statistically significant differences (P<0.05). (3) At1 month and 6 months after operation, the serum urea level of the observation group decreased compared with the preoperative level, and was significantly lower than the level of the control group, while the albumin (ALB) level increased. Compared with the control group, the levels of aminotransferase (ALT) and aspartate aminotransferase (AST) in the observation group were higher than those in the control group, but lower than those in the control group. The level of ALT and AST in the observation group was lower than that in the control group at 6 months after operation. There was significant difference between the control group and the observation group at 1 month after operation (P<0.05). At 1 month and 6 months after operation, the serum levels of endothelin (ET), AngiotensinⅡ(ATⅡ) and plasma renin activity (PRA) in the observation group decreased compared with preoperative period (P<0.05).

Conclusion

Laparoscopic cardia-vessel vascular detachment combined with TIPS can significantly improve liver and kidney function and portal hemodynamics in patients with cirrhotic portal hypertension and gastric fundus esophageal varices.

Key words: Hypertension, portal, Portasystemic shunt, transjugular intrahepatic, Esophageal and gastric varices, Liver cirrhosis

Wenhao Zhou, Xiaozhong Jiang, Changsong Wang, Bin Huang, Shaoyong Zhao, Jun Zhu. Effect of vascular disconnection combined with transjugular intrahepatic portosystemic shunt on portalblood flow and liver and kidney function in patients with portal hypertension and gastric esophageal varices[J]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(06): 450-454.

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URL: https://zhptwkxwx.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0793.2019.06.007

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References 16

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组别	例数	男/女(例)	年龄(岁,±s)	Child-Pugh分级(例)			疾病类型(例)
组别	例数	男/女(例)	年龄(岁,±s)	A	B	C	原发性胆汁性	酒精性肝炎	病毒性肝炎
观察组	47	31/16	66.27±4.29	8	29	10	3	6	38
对照组	47	32/15	67.10±4.15	7	31	9	5	6	36
统计值	?	χ²=0.067	t=0.126	χ²=0.083			χ²=0.054
P值	?	0.372	0.197	0.209			0.116

组别	例数	男/女(例)	年龄(岁,±s)	Child-Pugh分级(例)			疾病类型(例)
组别	例数	男/女(例)	年龄(岁,±s)	A	B	C	原发性胆汁性	酒精性肝炎	病毒性肝炎
观察组	47	31/16	66.27±4.29	8	29	10	3	6	38
对照组	47	32/15	67.10±4.15	7	31	9	5	6	36
统计值	?	χ²=0.067	t=0.126	χ²=0.083			χ²=0.054
P值	?	0.372	0.197	0.209			0.116

组别	例数	无效	有效	显效	总有效
观察组	47	2(4.26)	20(42.55)	25(53.19)	45(95.74)
对照组	47	8(17.02)	25(53.19)	14(29.79)	39(82.98)

组别	例数	无效	有效	显效	总有效
观察组	47	2(4.26)	20(42.55)	25(53.19)	45(95.74)
对照组	47	8(17.02)	25(53.19)	14(29.79)	39(82.98)

组别	SVF（md）				门体压力梯度（mmHg）				SVV（cm/s）
组别	术前	术后6个月	t值^a	P值	术前	术后6个月	t值^a	P值	术前	术后6个月	t值^a	P值
观察组(47例)	562.07±35.08	354.19±35.37	19.652	0.001	29.67±2.74	18.49±2.60	17.490	0.001	12.59±2.30	25.31±2.47	16.720	0.001
对照组(47例)	561.91±35.67	410.25±35.51	13.754	0.002	29.53±2.68	24.31±2.55	10.362	0.003	12.62±2.58	19.87±2.60	6.834	0.003
t值^b	0.338	6.710	?	?	0.503	9.530	?	?	0.473	7.653	?	?
P值	0.291	0.001	?	?	0.376	0.003	?	?	0.502	0.003	?	?
组别	PVD（cm）				SVD（cm）				PVF（ml）				PVV（cm/s）
组别	术前	术后6个月	t值^a	P值	术前	术后6个月	t值^a	P值	术前	术后6个月	t值^a	P值	术前	术后6个月	t值^a	P值
观察组(47例)	1.66±0.58	1.19±0.52	5.730	0.002	1.40±0.25	1.02±0.24	6.733	0.001	983.31±29.87	815.05±29.64	37.402	0.001	13.62±3.75	46.38±3.62	28.630	0.001
对照组(47例)	1.67±0.60	1.32±0.53	3.861	0.026	1.41±0.23	1.23±0.20	4.182	0.006	981.17±29.52	886.37±29.41	30.855	0.001	13.57±3.71	35.09±3.42	25.713	0.002
t值^b	0.334	4.173	?	?	0.073	3.850	?	?	0.076	5.823	?	?	0.035	12.673	?	?
P值	0.283	0.029	?	?	0.761	0.037	?	?	0.609	0.003	?	?	0.805	0.001	?	?

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