| Backgrounds:Portal venous system thrombosis(PVST)includes thrombosis of the main portal vein(MPV),portal vein branches,splenic vein,and superior mesenteric vein(SMV),which is mainly caused by portal vein hemodynamic abnormalities and coagulation abnormalities,and is more common in patients with liver cirrhosis(LC).The clinical symptoms of PVST patients vary from no obvious symptoms in mild cases to serious complications such as hematemesis,melena and even acute liver failure,acute intestinal necrosis and septic shock in severe cases.At present,the application of transjugular intrahepatic portosystemic shunt(TIPS)in the treatment of portal vein thrombosis(PVT)plays an increasingly important role,and PVT has become an absolute indication for TIPS.However,there are differences in the extent and degree of PVST,and there are still different views on whether different extent and degree of PVST have an impact on patients’liver function,hypersplenism(HS),and prognostic factors such as rebleeding,stent dysfunction,and hepatic encephalopathy(HE)after TIPS,and further studies are needed.Objectives:The purpose of this thesis is to analyze the clinical characteristics of different types and degrees of PVST and the efficacy and safety of TIPS on its treatment,and to conduct an in-depth study on the effects of TIPS treatment on liver function and hypersplenism in patients with PVST,as well as to investigate the effects of splenectomy(SP)and partial splenic embolization(PSE)on TIPS treatment of PVST.Methods:We retrospectively analyzed 67 patients with PVST treated by TIPS between2015-2021 at the Second Affiliated Hospital of Nanchang University,excluding patients with malignant neoplasms and multiple organ failure,and applied SPSS software to compare the related indexes of the clinical characteristics of patients with different types and degrees of PVST and the efficacy and safety of TIPS on them,the related indexes of hepatic function and hypersplenism in patients with PVST before and after treatment,and the prognostic indexes of TIPS combined with splenic surgery or TIPS treatment alone.Results:1.The effect of TIPS for portal vein system thrombosis was definite,with a mean follow-up period of 19.8±13.1 months,an incidence of rebleeding of 23.3%,an incidence of stent dysfunction of 16.9%,an overall survival(OS)rate of 95%,and an incidence of hepatic encephalopathy of 18.3%,and was particularly safe and effective for the prevention of rebleeding in cirrhosis.2.TIPS did not significantly improve hypersplenism in patients with portal vein system thrombosis,and there was a short-term postoperative increase in total bilirubin.3.Splenectomy may be associated with more severe portal vein system thrombosis(X~2=7.610,p=0.023).Different degrees of portal vein system thrombosis had a significant different effect on patients with hypersplenism,where the degree of thrombocytopenia was significantly associated with the degree of thrombosis(F=6.306,p=0.005;spearman correlation coefficient=-0.454,p=0.002),but there was no significant difference in platelet counts between the moderate and severe thrombosis groups(p=0.829).The degree of PVST was significantly correlated with the degree of elevation in C-reaction protein(CRP)(F=3.195,p=0.049;spearman correlation coefficient=0.336,p=0.011).4.No significant differences were seen in overall survival,incidence of rebleeding,improvement in thrombosis,or improvement in ascites between different types or degrees of PVST treated with TIPS.5.The incidence of complications such as hepatic encephalopathy and stent dysfunction did not show significant differences in different degrees of thrombosis as well as in different types of thrombosis.6.The combination of splenectomy,partial splenic embolization and TIPS did not show significant differences in the incidence of rebleeding,incidence of hepatic encephalopathy,overall survival rate,thrombosis and ascites improvement in patients with PVST compared with TIPS alone.7.Splenectomy was significantly better than TIPS combined with partial splenic embolization(p=0.004;p=0.000)and TIPS alone(p=0.005;p=0.000)in terms of increasing white blood cells and platelets,whereas there was no significant difference between TIPS alone and TIPS combined with partial splenic embolization in increasing long-term platelet(p=0.150)and white blood cell(p=0.388)in hypersplenic patients.Conclusions:TIPS is definitive in the treatment of portal vein system thrombosis,and although TIPS did not show significant improvement in hypersplenism in patients with PVST,as well as have some reversible damage to postoperative liver function,but show special safeness and effectiveness in the prevention of rebleeding in cirrhosis. |
