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Nov.  2016
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Article Navigation >  Journal of Clinical Hepatology  > 2016  >  32(11): 2112-2117

Effect of transjugular intrahepatic portosystemic shunt combined with splenic artery embolization on hepatic hemodynamics and liver function in patients with liver cirrhosis

DOI: 10.3969/j.issn.1001-5256.2016.11.021
  • Published Date: 2016-11-20
    Abstract
  • Objective To investigate the effect of transjugular intrahepatic portosystemic shunt( TIPS) combined with splenic artery embolization( SAE) on hepatic hemodynamics,liver function,and prognosis in patients with liver cirrhosis. Methods A total of 24 patients who underwent TIPS in the Department of Gastroenterology in Drum Tower Hospital from September 2014 to June 2015 were enrolled and divided into TIPS group( 14 patients) and TIPS- SAE group( 10 patients) according to whether TIPS was used in combination with SAE. Color Doppler was used to measure the diameter,blood flow rate,and blood flow volume of the hepatic artery and portal vein before and after treatment; liver function parameters including alanine aminotransferase( ALT),aspartate aminotransferase( AST),and total bilirubin( TBil)were measured before and after surgery; the incidence of postoperative complications such as hepatic encephalopathy( HE) and splenic abscess was observed in the two groups. The Wilcoxon rank sum test was used for comparison of parameters before and after treatment within each group,and the Mann- Whitney U test was used for comparison of parameters between the two groups. Results At 5 days after surgery,the TIPS- SAE group showed significant increases in hepatic artery blood flow rate [200. 00( 168. 25- 224. 75) vs 91. 35( 76. 00-113. 25),Z = 2. 803,P = 0. 005],portal vein blood flow rate [60. 30( 49. 85- 75. 70) vs 28. 30( 21. 20- 30. 00),Z = 2. 666,P =0. 008 ],and hepatic artery blood flow volume [188. 00( 172. 00- 232. 00) vs 79. 10( 61. 15- 89. 75),Z = 2. 803,P = 0. 005],a significant reduction in portal vein pressure [29. 50( 24. 50- 34. 00) vs 38. 00( 34. 00- 41. 75),Z =- 2. 668,P = 0. 008],and significant increases in ALT [61. 30( 28. 55- 139. 60) vs 21. 10( 14. 00- 26. 95),Z = 2. 429,P = 0. 015],AST [43. 70( 22. 67- 106. 27) vs 23. 20( 20. 97- 36. 87),Z = 2. 599,P = 0. 009],and TBil [31. 75( 17. 95- 36. 92) vs 15. 35( 13. 10- 18. 62),Z = 2. 803,P = 0. 005]. The TIPS- SAE group showed a significantly higher level of AST at 30 days after surgery[49. 00( 12. 10 ~ 58. 35) U / L vs 23. 20( 20. 97 ~36. 87) U / L]( t = 2. 100,P = 0. 036). At 30 days after surgery,the TIPS group showed a significantly higher level of TBil than the TIPS-SAE group [35. 00( 24. 00- 51. 25) vs 18. 30( 12. 55- 31. 00),Z =- 2. 371,P = 0. 017]. At three month after surgery,one patient in the TIPS group developed HE( grade 2),and in the TIPS- SAE group,one patient experienced HE( grade 3) and 2 experienced splenic abscess. Conclusion After TIPS,hepatic artery infusion is significantly increased. SAE cannot further increase liver perfusion after TIPS;however,it may aggravate postoperative liver impairment within a short time and cannot improve the prognosis of patients.

     

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