Effect Of Different Portal Vein Branches Puncture Shunt Via Jugular Vein On Serum Ammonia Level In Patients With Liver Cirrhosis

Objective:To investigate the effect of different portal vein branches puncture shunt via jugular vein on serum ammonia level in patients with liver cirrhosis,and to observe its effect on hepatic encephalopathy,shunt dysfunction,rebleeding and ascites.Methods The clinical data of 71 patients with cirrhosis who underwent transjugular intrahepatic portosystemic shunt(TIPS)for gastrointestinal bleeding from March 2015 to March 2017 were collected.According to the location of puncture,the patients were divided into two groups: 30 cases in tansjugular intrahepatic left branch of portal vein shunt group(L group)and 41 cases in tansjugular intrahepatic right branch of portal vein shunt group(R group).The blood ammonia levels of different branches of portal vein system in the two groups were detected and compared,ammonia levels in arterial blood and venous blood of the patients before and after shunt was compared.The portal vein pressure before and after shunt was also measured,and the incidence of hepatic encephalopathy,shunt dysfunction,rebleeding and ascites were recorded.Results:There was no significant difference in the portal pressure between the two groups before and after operation(P > 0.05).The postoperative portal pressure of the two groups were both significantly lower than that before operation(P < 0.05)..In portal vein system,the concentration of ammonia in the splenic vein was the lowest(32.2�9.5)mol/L)(L group)and(30.6 �8.6)mol/L(R group),respectively.The concentration of ammonia in superior mesenteric vein was the highest,which was(69.1�22.1)mol/L and(68.6�18.3)mol/L respectively in L group and R group.There was no significant difference of the concentration of ammonia between the two groups after TIPS,respectively in left and right branches of portal vein,splenic vein and main vein of superior mesenteric vein(P > 0.05).The results of variance analysis of repeated measurements showed that the time effect,interaction effect and inter-group effect of blood ammonia concentration in arteriovenous blood had statistical significance(P < 0.001).In the L group,the blood ammonia concentration at different time points after operation was higher than that before operation,and the blood ammonia concentration in the arterial and venous blood increased significantly at the six months after operation compared with that at three months after operation(P < 0.001),and the blood ammonia concentration in the arterial blood was higher than that in the venous blood at any time points(P < 0.001).In the R group,the blood ammonia concentration at different time points after operation was higher than that before operation.However,the blood ammonia concentration in artery was higher than that in vein at any time points after operation(P < 0.001),and there was no significant difference in preoperative blood ammonia concentration between artery and vein(P > 0.05).In arterial blood,the time effect,interaction effect and inter-group effect of blood ammonia concentration between two groups had statistical significance(P < 0.001).In venous blood,only the time effect and interaction effect of blood ammonia concentration between two groups were statistically significant(P < 0.001).In arterial blood,the concentration of ammonia in L group was lower than that in R group at 1 day and 3 months after operation(P < 0.05);in venous blood,there was no significant difference between the two groups at different time points(P > 0.05).The incidence of stent dysfunction in L group was significantly lower than that in R group(P < 0.05).After TIPS,There were no significant differences in the incidence of hepatic encephalopathy,upper gastrointestinal bleeding rate and ascites rate between the two groups(P > 0.05).Conclusion:The difference of the anatomical distribution of different branches of portal vein will affect the blood ammonia concentration.Among them,the blood ammonia concentration of splenic vein is the lowest and that of superior mesenteric vein is the highest.After TIPS operation,the concentration of blood ammonia will increase obviously,but the increase of blood ammonia after left branch shunt is lower than that after right branch shunt,which may affect the occurrence of hepatic encephalopathy after TIPS.Left branch shunt and right branch shunt have the same effect on reducing portal vein pressure,but the incidence of stent stenosis or occlusion is relatively lower in the former,suggesting that left branch shunt is superior to right branch shunt.