| Objectives:Transjugular intrahepatic portosystemic shunt(TIPS)is an effective method for the treatment of esophagogastric varices in patients with liver cirrhosis by reducing portal pressure to eliminate esophagogastric varices and prevent rebleeding in cirrhotic patients with esophagogastric variceal bleeding(EGVB).However,some patients still experience rebleeding after TIPS,which affects the long-term efficacy.This study explored the possible influencing factors of early,mid-and long-term rebleeding after TIPS,and provided a reference for the prevention and treatment strategies of rebleeding after TIPS in cirrhotic patients with EGVB.Methods:A retrospective analysis was performed on 293 patients who underwent TIPS in gastroenterology department of East Hospital of Shandong Provincial Hospital due to portal hypertension associated with esophagogastric variceal bleeding(once)from June 2010 to June 2020.Patients were followed up 1 month,3 months and 6 months after surgery in outpatient department or by telephone for rebleeding and stent patency,and then followed up every 6 months.The follow-up time of 293 patients in this study was longer than 12 months,with an average follow-up time of 49.7±26.3 months.Medical records and follow-up records were reviewed to collect preoperative laboratory indicators,preoperative Child-Pugh score,hepatic venous pressure gradient(HVPG),intraoperative stent diameter and type,postoperative portal pressure gradient(PPG),postoperative regular endoscopic evaluation,postoperative stent patency and other data.The possible influencing factors of early and medium and long-term rebleeding after TIPS were analyzed.SPSS 25.0 software was used for statistical analysis.The measurement data were compared using the t test or non-parametric test,and the enumeration data were compared using the χ2 test or Fisher’s exact probability test.Statistically significant single factors were incorporated into the Cox proportional hazards regression model for multivariate analysis,and the cumulative no rebleeding rate was analyzed using Kaplan-Meier curves.Significance level P<0.05 was statistically significant.Results:1.Among the 293 patients,8 patients(2.7%)rebled within 6 weeks after TIPS.There were 50 cases(17.1%)of rebleeding within 1 year after operation,and 63 cases(34.1%)of rebleeding within 3 years after operation(n=185).2.The possible risk factors for rebleeding 6 weeks after operation were preoperative splenectomy or splenic artery embolization,and preoperative lower fasting glucose level[4.95(4.46,5.30)mmol/L](P<0.05).Preoperative splenectomy or splenic artery embolization(HR=10.229,95%CI 1.472-71.089,P=0.019),preoperative lower fasting blood glucose level(HR=0.364,95%CI 0.140-0.976,P=0.038)was an independent risk factor for rebleeding 6 weeks after TIPS.3.The possible risk factors for rebleeding 1 year after surgery were preoperative liver cancer,ascites,high preoperative total bilirubin level,low blood Na,high MELD-NA score,type of esophagogastric varices(GOV1 and GOV2 bleeding rates were higher than EV and IGV),emergency TIPS(higher than secondary prevention TIPS),7mm diameter stents(compared with 8mm diameter stents)and stent stenosis or blockage within 1 year after surgery(P<0.05),postoperative endoscopic follow-up assessment could reduce the one-year postoperative rebleeding rate(P<0.05).Preoperative liver cancer(HR=5.879,95%CI 2.33614.799,P<0.001),higher preoperative total bilirubin level(HR=1.033,95%CI 1.001-1.066,P=0.041),preoperative ascites(HR=2.593,95%CI 1.040-6.467,P=0.041)and stent stenosis or blockage within 1 year after surgery(HR=12.613,95%CI 5.547-28.683,P<0.001)were independent risk factors for rebleeding within 1 year after TIPS.Endoscopic follow-up assessment within 1 year after TIPS(HR=0.488,95%CI 0.241-0.990,P=0.047)was an independent protective factor for rebleeding within 1 year after TIPS.4.The possible risk factors for rebleeding 3 years after surgery include gender(male),preoperative liver cancer,ascites,higher ALT level,higher GGT level,lower blood Na level,type of esophageal and gastric varicose veins(GOV1 type is higher than IGV1 type),emergency TIPS(higher than secondary prevention TIPS),stent stenosis or blockage.Endoscopic followup assessment within 1 year after surgery could reduce the rebleeding rate 3 years after surgery(P<0.05).Preoperative ascites(HR=2.694,95%CI 1.304-5.567,P=0.007)and stent stenosis or blockage within 3 years after surgery(HR=4.510,95%CI 2.363-8.608,P<0.001)were independent risk factors for rebleeding within 3 years after TIPS.Results:1.Preoperative splenectomy or splenic artery embolization and preoperative lower fasting glucose levels were independent risk factors for early postoperative rebleeding(6 weeks).2.Preoperative concomitant liver cancer,preoperative higher total bilirubin level,ascites,and stent stenosis or blockage 1 year after surgery were independent risk factors for mid-term(1 year)rebleeding after TIPS,while endoscopic follow-up within 1 year after surgery was independent protective factors.3.Preoperative ascites and stent stenosis or blockage 3 years after surgery were independent risk factors for long-term(3 years)rebleeding after TIPS. |
