Abstract

Background

This study aimed to compare postoperative complications in patients with esophagogastric variceal bleeding (EVB) who underwent laparoscopic splenectomy combined with pericardial devascularization (LSPD) versus transjugular intrahepatic portosystemic shunt (TIPS) procedures.

Methods

A retrospective collection of medical records was conducted from January 2014 to May 2020 at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. The study included patients from the departments of trauma surgery, interventional radiology, and general surgery who were diagnosed with EVB caused by portal hypertension and treated with LSPD or TIPS. Follow-up data were obtained to assess the occurrence of postoperative complications in both groups.

Results

A total of 201 patients were included in the study, with 104 cases in the LSPD group and 97 cases in the TIPS group. There was no significant difference in the 1-year and 3-year post-surgery survival rates between the TIPS and LSPD groups (P = 0.669, 0.066). The 3-year survival rate of Child–Pugh B patients in the LSPD group was higher than TIPS group (P = 0.041). The LSPD group also had a significantly higher rate of freedom from rebleeding at 3-year post-surgery compared to the TIPS group (P = 0.038). Stratified analysis showed no statistically significant difference in the rebleeding rate between the two groups. Furthermore, the LSPD group had a higher rate of freedom from overt hepatic encephalopathy at 1-year and 3-year post-surgery compared to the TIPS group (P = 0.007, < 0.001). The LSPD group also had a lower rate of severe complications at 3-year post-surgery compared to the TIPS group (P = 0.020).

Conclusion

Compared to TIPS, LSPD does not increase the risk of mortality and rebleeding, while demonstrating fewer complications. In patients classified as Child–Pugh A and B, the use of LSPD for treating EVB is both safe and effective.

中文翻译：

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LSPD 与 TIPS 治疗肝硬化食管胃静脉曲张出血的预后

摘要

背景

本研究旨在比较食管胃静脉曲张出血（EVB）患者接受腹腔镜脾切除联合心包断流术（LSPD）与经颈静脉肝内门体分流术（TIPS）手术的术后并发症。

方法

回顾性收集华中科技大学同济医学院附属协和医院2014年1月至2020年5月的病历。该研究纳入了来自创伤外科、介入放射科和普外科的被诊断为门脉高压引起的 EVB 并接受 LSPD 或 TIPS 治疗的患者。获得随访数据以评估两组术后并发症的发生情况。

结果

该研究共纳入201例患者，其中LSPD组104例，TIPS组97例。TIPS组和LSPD组术后1年和3年生存率差异无统计学意义（P  =0.669、0.066）。LSPD组Child-Pugh B级患者3年生存率高于TIPS组（P  =0.041）。与 TIPS 组相比，LSPD 组术后 3 年的再出血率也显着更高（P  = 0.038）。分层分析显示两组再出血率无统计学差异。此外，与 TIPS 组相比，LSPD 组术后 1 年和 3 年无明显肝性脑病的比率较高（P  = 0.007，< 0.001）。与 TIPS 组相比，LSPD 组术后 3 年的严重并发症发生率也较低（P  = 0.020）。

结论

与 TIPS 相比，LSPD 不会增加死亡和再出血的风险，同时并发症也更少。对于 Child-Pugh A 和 B 级患者，使用 LSPD 治疗 EVB 既安全又有效。