| Background and objectivePortal hypertension(PHT)is a group of clinical syndromes caused by the obstruction and/or increase of blood flow of portal vein system,its clinical manifestations mainly include:the establishment of collateral circulation,splenomegaly and hypersplenism,portal hypertensive gastropathy and ascites.Esophageal gastric variceal bleeding(EGVB)caused by portal hypertension is the most common and dangerous complication and is also the highest cause of death in patients with cirrhosis.Open splenectomy with periesophagogastric devascularization(OSPD)was the main treatment of EGVB in the past,but it can easily lead to portal vein thrombosis,ectopic varices and portal hypertensive gastropathy.With the development of Trans jugular intrahepatic portosystemic shunt(TIPS)in recent years,TIPS has gradually become the first-line treatment for EGVB,but its long-term clinical efficacy needs further research.There are some differences between OSPD and TIPS in treating EGVB.Therefore,this study is aimed to compare the clinical efficacy of OSPD and TIPS in treating of EGVB,and to provide optimum treatment method of EGVB.MethodsA retrospective analysis was conducted on 171 patients who underwent OSPD and TIPS treatment in the Department of Hepatobiliary Surgery and Interventional Surgery of Nan fang Hospital of Southern Medical University from January 1,2014 to December 31,2016 due to EGVB caused by portal hypertension.According to different treatment methods,they were divided into OSPD group(n=83)and TIPS group(n =88).Compare and analyze the general clinical data,the results of laboratory test on blood routine and hepatorenal function in the two groups,portal vein pressure before and after surgery in the two groups,postoperative clinical data.Data analysis was performed using SPSS 22.0 statistical software.The normal distribution of measurement data was expressed as mean±standard deviation(x±s)the student t-test was used for comparison between groups.The non-normal distribution data was expressed as median;Wilcoxon rank sum test was used for comparison between groups.The count data was described by percentage(%),and the ?2 test was used for comparison between groups.P<0.05 was considered statistically significant.Results1.There were 83 cases in the OSPD group,among which 63 cases were males and 20 cases were females,and their average age is 48.8±10.7 years.There were 88 cases in the TIPS group,including 74 males and 14 females,and their average age is 48.7±10.3 years.In the OSPD group,there were 6 cases of alcoholic cirrhosis,1 case of schistosomiasis cirrhosis,1 case of hepatitis C viral cirrhosis,66 cases of hepatitis B viral cirrhosis and 9 cases of cryptogenic cirrhosis.In the other group,there are 9 cases with alcoholic cirrhosis,1 case with clonorchis sinensis cirrhosis,2 cases with hepatitis C viral cirrhosis,67 cases with hepatitis B viral cirrhosis,4 cases with cryptogenic cirrhosis,1 case with Wilson's disease cirrhosis,and 4 cases with Budd-Chiari syndrome cirrhosis.According to Child-Pugh grades of hepatic function,52 patients were degree A,26 patients were degree B and 5 patients were degree C in the OSPD group.But in the TIPS group,35 cases were degree A,41 cases were degree B and 12 cases were degree C.2.In the OSPD group,the portal vein pressure was 35.4 ± 4.0 cmH2O(1cmH2O=0.098kpa)at the beginning of operation and(29.8± 6.6)cmH2O after operation;in the TIPS group,the portal vein pressure was(38.9± 7.4)cmH2O before operation and(25.2± 5.6)cmH2O after operation.There was a significant difference in portal pressure between the two groups before and after surgery(P<0.05).3.Compared with the TIPS group,the OSPD group has the following advantages:(1)the count of white blood cells,red blood cells,hemoglobin and platelets in the postoperative 1 week and 1-3 months were higher than those of TIPS group(P<0.05);(2)the prothrombin time in the postoperative 1 week and 1-3 months was shorter than that of TIPS group(P<0.05);(3)the albumin in the postoperative 1 week and 1-3 months was higher than that of TIPS group(P<0.05);(4)the total bilirubin in the postoperative 1 week and 1-3 months was lower than that of TIPS group(P<0.05);(5)the alanine aminotransferase in the postoperative 1 week was lower than that of TIPS group(P<0.05).4.The total hospitalization cost in the OSPD group was 62707.0 yuan(30686-117836),and that in TIPS group was 86945.5 yuan(60523-189845).The difference between the two groups was statistically significant(P<0.05);the total postoperative hospital stay in the OSPD group was 9(6-33)days,and that in TIPS group was 5(2-15)days,and the difference between the two groups was statistically significant(P<0.05).5.There were 64 patients with postoperative complications in the OSPD group and 15 cases in the TIPS group.The incidence of complications in the two groups were 77.11%and 17.05%respectively.There was significant difference in the incidence of postoperative complications between the two groups(P<0.05).6.There were 8 deaths in the two groups during the follow-up.The mortality rates of the two groups were 9.64%and 9.09%respectively.There was no significant difference between the two groups(P>0.05).7.The re-bleeding rates in the OSPD group in the 1,2,3,4 and 5 years were 4.69%,7.14%,9.61%,15.15%and 28.57%respectively.and in the TIPS group were 11.11%,17.33%,26.32%,51.35%and 86.36%respectively.There were no significant differences in the re-bleeding rate between the two groups in the 1 and 2 years after operation(P>0.05),and there were significant differences in the 3,4 and 5 years after operation(P<0.05).Conclusions1.The blood routine(white blood cells,red blood cells,hemoglobin,platelets)and liver function(prothrombin time,albumin,total billirubin)were significantly improved in the OSPD group.However,the blood routine and liver function in the TIPS group did not improve significantly.2.Compared with the TIPS group,the total postoperative hospital stay in the OSPD group was relatively longer,but the total hospitalization cost was relatively lower.3.Compared with the TIPS group,the overall incidence of perioperative complications was higher in the OSPD group,but the incidence of hepatic encephalopathy was higher in tips group.4.Compared with the TIPS group,the long-term re-bleeding rate(in the 3-5 years after surgery)in the OSPD group was significantly lower than that in the TIPS group. |
PDF Full Text Request