Background

Studies about treatment of patients with chronic portal vein thrombosis (CPVT) are still limited, especially in different types of CPVT. This study aimed to evaluate the effect of transjugular intrahepatic portosystemic shunt (TIPS) in all types of CPVT with variceal bleeding.

Methods

Patients with CPVT who received TIPS treatment between January 2011 and June 2019 were divided into four types according to the extent of thrombosis. All patients had a history of variceal bleeding. The characteristics and clinical parameters were collected and recorded. Data on procedure success rate, variation in portal vein pressure, rebleeding, hepatic encephalopathy (HE), stent stenosis, and overall mortality were analyzed.

Results

A total of 189 patients were included in this study (39 in type 1, 84 in type 2, 48 in type 3, 18 in type 4). The TIPS procedure success rate was 86.2%. The success rate was significantly different among the four types (89.7% vs. 88.1% vs. 83.3% vs. 77.8%, P = 0.001). In the TIPS success group, portal vein pressure was significantly reduced from 27.15 ± 6.59 to 19.74 ± 6.73 mmHg after the procedure (P < 0.001) and the rebleeding rate was significantly lower than that of the fail group (14.7% vs. 30.8%, P = 0.017). In addition, there were no significant differences in HE rate (30.7% vs. 26.9%, P = 0.912) or overall mortality (12.9% vs. 19.2%, P = 0.403) between the TIPS success group and the fail group. In the TIPS success group, we found that the occurrence of HE was significantly different (P = 0.020) among the four types, while there were no significant differences in rebleeding rate (P = 0.669), stent stenosis rate (P = 0.056), or overall mortality (P = 0.690).

Conclusions

TIPS was safe and effective in decreasing portal vein pressure and rebleeding rate in patients with CPVT.

中文翻译：

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经颈静脉肝内门体分流术对慢性门静脉血栓形成和静脉曲张出血患者有效

背景

慢性门静脉血栓形成（CPVT）患者的治疗研究仍然有限，尤其是在不同类型的CPVT中。本研究旨在评估经颈静脉肝内门体分流术 (TIPS) 对所有类型 CPVT 伴静脉曲张出血的影响。

方法

2011 年 1 月至 2019 年 6 月期间接受 TIPS 治疗的 CPVT 患者根据血栓形成程度分为四类。所有患者均有静脉曲张出血史。收集并记录特征和临床参数。分析了手术成功率、门静脉压力变化、再出血、肝性脑病 (HE)、支架狭窄和总死亡率的数据。

结果

本研究共纳入 189 名患者（1 型 39 名、2 型 84 名、3 型 48 名、4 型 18 名）。TIPS 手术成功率为 86.2%。四种类型的成功率有显着差异（89.7% vs. 88.1% vs. 83.3% vs. 77.8%，P  = 0.001）。TIPS成功组门静脉压力从27.15±6.59显着降低至19.74±6.73mmHg（P <0.001），再出血率显着低于失败组（14.7% vs.30.8%，P  = 0.017）。此外，HE 率（30.7% 与 26.9%，P  = 0.912）或总死亡率（12.9% 与 19.2%，P = 0.403) 在 TIPS 成功组和失败组之间。在TIPS成功组中，我们发现 4种类型的HE发生率有显着差异（P =0.020），而再出血率（P  =0.669）、支架狭窄率（P  =0.056）、或总体死亡率（P  = 0.690）。

结论

TIPS 可安全有效地降低 CPVT 患者的门静脉压力和再出血率。