| Background:Liver cirrhosis is a final stage change of chronic hepatic disease.Portal vein hypertension is the most prominent characteristic of cirrhosis.The one of portal vein hypertension’s main feature is Collateral circulation formation,one more common type of which is Spontaneous splenorenal shunts(SSRS).SSRS could significantly reduce portal vein pressure.However,SSRS would reduce the liver blood flow from portal vein system;its prognostic role in patients with cirrhosis has been fully controversial so far.Objective:The aim of this study was to investigate the clinical characteristics of SSRS in cirrhosis patients with portal hypertension and to explore the role of SSRS in cirrhosis progression.Materials and methods:Between January 2012 and June 2016,data were collected from the inpatients with cirrhosis due to ascites and Gastrointestinal bleeding.We determined whether there was an SSRS by CT,selecting 30 patients with Spontaneous splenorenal shunts as a test group(SSRS group)and randomly 50 patients with Non-SSRS as a control group(Non-SSRS group).These patients general condition,medical history characteristics,serum biochemical parameters,electronic endoscopy,abdominal ultrasonography and abdominal CT and other information are collected.Then applying SPSS17.0 software for statistical analysis.Results:A total of 266 patients with cirrhosis were identified,including 30 with SSRS,including 21 spleen-renal shunts and 9 gastric-renal shunts.The incidence of SSRS was 11.2%.The diameter of spleen and kidney shunt was 7.9 to 31.5 mm(15.5 ± 5.25)mm,and the diameter of the gastric and renal shunt was approximately 5.4 to 16.8mm(11.4 ± 3.43)mm.Contrasting SSRS Groups and Non-SSRS Groups,the serum levels of albumin,bilirubin,INR,creatinine,and PT,there was no significant change in the albumin,bilirubin,INR,and creatinine,and the difference was not statistically significant(P>0.05).However,SSRS had an effect on PT and the difference was statistically significant(P=0.004<0.05).The presence of SSRS is related to the diameter of the main trunk and the left and right branches of the portal vein,which had no impact on the diameter of the splenic vein and the superior mesenteric vein.It showed that the internal diameter of splenorenal shunt was linearly correlated with the diameter of portal vein and the internal diameter of splenic vein in the SSRS group,suggesting that the greater the internal diameter of splenorenal shunt,the finer the portal vein trunk(P<0.05)and the thicker the splenic vein(P<0.05).The incidence of hepatic encephalopathy in the SSRS group and Non-SSRS group was23.3%,6%,which was statistically significant(P<0.001).Without ascites,in SSRS group and non-SSRS group,the rates was 43.3%,26%,and the moderately-severe ascites was 13.4%,42% respectly,the difference was statistically significant(P=0.017).SSRS could reduce the formation of ascites.Without esophageal varices the rates in two groups were 36.7%,16%,and moderate-to-severe varicosities were26.6%,64% respectly,the difference was statistically significant(P=0.0001).SSRS could reduce the occurrence of esophageal varices.The incidence of portal vein thrombosis was 21.25%,including 11 cases in SSRS group and 6 cases in Non-SSRS group(P=0.012<0.05),indicating that cirrhosis with SSRS increased portal vein thrombosis.The rate of gastrointestinal hemorrhage rate in the study was 33.75%,while there were 9 cases in the SSRS group and 18 cases in the Non-SSRS group.The difference was not statistically significant(P>0.05),which suggested that the SSRS has no effect on the occurrence of gastrointestinal bleeding.Conclusion:Spontaneous splenorenal shunts could induce massive blood flowing into the systemic circulation through the shunt,and reduce the diameter of portal vein trunk and its branches,which would result in decreasing liver blood perfusion.SSRS could increased the incidence of portal vein thrombosis,which would further reduce liverblood flow.Therefore,spontaneous splenorenal shunts could accelerate the progression of cirrhosis. |
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