Comparative clinical analysis of three surgical methods in patients with cirrhotic portal hypertension complicated by upper gastrointestinal bleeding

Objective To compare the effects of transjugular intrahepatic portosystemic shunt( TIPS),percutaneous transhepatic variceal embolization( PTVE),and TIPS combined with gastric coronary vein embolization( GCVE) in patients with cirrhotic portal hypertension complicated by upper gastrointestinal bleeding. Methods A total of 167 patients with cirrhotic portal hypertension complicated by upper gastrointestinal bleeding who underwent surgical treatment in Tongchuan Mining Bureau Central Hospital from January 2012 to October 2014 were analyzed retrospectively and divided into TIPS group( 56 patients),PTVE group( 53 patients),and TIPS- GCVE group( 58 patients) according to the difference in surgical method. The time of operation,time to postoperative recovery,hospital costs,postoperative improvement in gastrointestinal varices,incidence of rebleeding,incidence of hepatic encephalopathy,ascites elimination rate,indices related to the portal vein( diameter of the portal vein,portal vein velocity,portal venous pressure),and liver function parameters( ALT,AST,TBil,and Alb) were compared between the three groups. Comparison of continuous data between these groups was made by analysis of variance,and pairwise comparison was made by SNK- q test; comparison of categorical data between these groups was made by chis- quare test.Results There were significant differences in the time of operation,hospital costs,incidence of postoperative rebleeding,and incidence of postoperative hepatic encephalopathy between the three groups( F = 13. 85 and 12. 53,respectively,χ2= 7. 132 and 6. 368,respectively,all P < 0. 05). The hospital costs showed a significant difference between the TIPS group and the PTVE group( q = 2. 84,P < 0. 05); there were significant differences in the time of operation,hospital costs,incidence of postoperative rebleeding,and incidence of postoperative hepatic encephalopathy between the TIPS group and the TIPS- GCVE group( q = 3. 99 and 2. 58,respectively,χ2= 7. 396 and 6. 183,respectively,all P < 0. 05); there were significant differences in the time of operation,hospital costs,incidence of postoperative rebleeding,and incidence of postoperative hepatic encephalopathy between the PTVE group and the TIPS- GCVE group( q = 4. 53 and 3. 99,respectively,χ2=7. 534 and 5. 461,respectively,all P < 0. 05). Conclusion Although TIPS- GCVE has longer time of operation and higher hospital costs than TIPS and PTVE,it can significantly reduce the incidence of postoperative rebleeding and hepatic encephalopathy.