Prognosis after splenectomy plus pericardial devascularization <i>vs</i> transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding

作者全名："Qi, Wei-Li; Wen, Jun; Wen, Tian-Fu; Peng, Wei; Zhang, Xiao-Yun; Shen, Jun-Yi; Li, Xiao; Li, Chuan"

作者地址："[Qi, Wei-Li; Wen, Jun; Wen, Tian-Fu; Peng, Wei; Zhang, Xiao-Yun; Shen, Jun-Yi; Li, Chuan] Sichuan Univ, West China Hosp, Dept Liver Surg, Chengdu 610041, Sichuan Provinc, Peoples R China; [Wen, Jun] Southwest Jiaotong Univ, Affiliated Hosp, Peoples Hosp Chengdu 3, Dept Gen Surg,Sect HepatoPancreatoBiliary Surg, Chengdu 610041, Sichuan Provinc, Peoples R China; [Wen, Jun] Chongqing Med Univ, Affiliated Hosp Chengdu 2, Chengdu 610041, Sichuan Provinc, Peoples R China; [Li, Xiao] Sichuan Univ, West China Hosp, Dept Intervent Therapy, Chengdu 610041, Sichuan Provinc, Peoples R China; [Li, Xiao] Chinese Acad Med Sci & Peking Union Med Coll, Canc Hosp, Natl Canc Ctr, Dept Intervent Therapy,Natl Clin Res Ctr Canc, Beijing 100000, Peoples R China; [Li, Chuan] Sichuan Univ, West China Hosp, Dept Liver Surg, 37 Guoxue Lane, Chengdu 610041, Sichuan Provinc, Peoples R China"

通信作者："Li, C (通讯作者)，Sichuan Univ, West China Hosp, Dept Liver Surg, 37 Guoxue Lane, Chengdu 610041, Sichuan Provinc, Peoples R China."

来源：WORLD JOURNAL OF GASTROINTESTINAL SURGERY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001080916200008

JCR分区：Q2

影响因子：1.8

年份：2023

卷号：15

期号：8

开始页：1641

结束页：1651

文献类型：Article

关键词：Portal hypertension; Liver cirrhosis; Esophagogastric variceal bleeding; Splenectomy; Pericardial devascularization; Transjugular intrahepatic portosystemic shunt

摘要："BACKGROUNDPortal 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.AIMTo 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.METHODSThis 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.RESULTSThe 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).CONCLUSIONCompared 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."

基金机构：National Key R&D Program of China [2022YFC2503701]; Science and Technological Supports Project of Sichuan Province [2022YFS0255]; National Natural Science Foundation of China [81800449]

基金资助正文："Supported by the National Key R & D Program of China, No. 2022YFC2503701; the Science and Technological Supports Project of Sichuan Province, No. 2022YFS0255; and the National Natural Science Foundation of China, No. 81800449."