| Objective:To investigate the effect of transjugular intrahepatic portosystemic shunt(TIPS)on hypersplenism after treatment of patients with cirrhosis and portal hypertension.Methods:The clinical data of 187 patients with liver cirrhosis and esophagogastric varices who received TIPS as a secondary prevention method from March 2016 to September 2020 in our center was retrospectively analyzed.According to different causes,the patients were divided into three groups:hepatitis B cirrhosis,alcoholic cirrhosis and autoimmune cirrhosis.The platelet count,white blood cell count,spleen morphology,Child-Pugh score,occurrence of hepatic encephalopathy and survival status of the three groups were analyzed.The follow-up time was in 1,3,6,12,and 24 months after operation.Result:There was no significant difference in PLT count between postoperative and preoperative in all patients(all P>0.05),and there was no significant difference in PLT count among the three groups at each follow-up time(all P>0.05).The WBC count in 1 month after operation was higher than that before operation(t=-2.57,P=0.011),and the WBC count at other time was not significantly different from that before operation(all P>0.05).There was no significant difference in WBC count among the three groups at each follow-up time after operation(all P>0.05).The length of the spleen in 6,12,and 24 months after the operation was smaller than that before operation(all P<0.05),and there was no significant difference in the length of the spleen at the rest of the time(all P>0.05).There was no significant difference in the length of the spleen among the three groups at each follow-up time(all P>0.05).The thickness of spleen at each follow-up time after operation was smaller than that before operation(all P<0.05).There was no significant difference in spleen thickness among the three groups at each follow-up time(all P>0.05).The Child-Pugh scores of all patients in 1,3,and 6 months after operation were higher than those before operation(all P<0.05),but the score in 12 or 24 months after operation was not significantly different from that before operation(all P>0.05).In 24 months after operation,the Child-Pugh score of hepatitis B cirrhosis group was lower than that of alcoholic cirrhosis group and autoimmune cirrhosis group,and the difference was statistically significant(F=5.93,P=0.003).There was no significant difference in the score among the three groups at the rest of the follow-up time(all P>0.05).The overall survival rates in 12,and 24 months after TIPS were 90.3%and 82.6%,respectively.The survival rate of hepatitis B cirrhosis group was higher than that of the other two groups in 12,and 24 months after operation,but there was no statistical significance(Log Rank χ~2=2.808,P=0.246).The overall incidence of hepatic encephalopathy was 11.8%,16.6%,18.3%,20.0%,and 25.6%in 1,3,6,12,and 24 months after operation,respectively.Hepatic encephalopathy mainly occurred in 3 months after surgery.There was no significant difference in the 24-month cumulative incidence among the three groups(Log Rank χ~2=1.684,P=0.431).Conclusion:1.Although TIPS is recognized as an effective treatment for the complications of portal hypertension in cirrhosis,even if portal hypertension is relieved after TIPS,there is no significant improvement in peripheral thrombocytopenia and leukopenia in patients with cirrhosis.2.After TIPS,the spleen blood stasis and swelling were relieved compared with before,but thrombocytopenia and leukopenia did not improve during the same time,suggesting that the change of peripheral blood cells may not be significantly related to splenomegaly.3.TIPS-related liver function impairment and hepatic encephalopathy occur mainly in the early time after TIPS,and the long-term liver function of patients with hepatitis B cirrhosis may be better than that of patients with alcohol or autoimmune cirrhosis. |
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