Comparative Analysis Of The Efficacy Of Transmesenteric Vein Extrahepatic Portosystemic Shunt And Transjugular Intrahepatic Portosystemic Shunt In The Treatment Of Cavernous Transformation Of The Portal Vein

Objective:To compare the safety and efficacy of transmesenteric vein extrahepatic portosystemic shunt(TEPS)and transjugular intrahepatic portosystemic shunt(TIPS)in the treatment of portal hypertension(PHT)with cavernous transformation of the portal vein(CTPV).To evaluate the feasibility and technical advantages of TEPS in the treatment of PHT with CTPV.Method:To analyze the clinical data of patients with PHT and CTPV who were treated with TIPS or TEPS in the vascular surgery of Henan Provincial People’s Hospital from June 2019 to August 2022 and whose main trunk of the superior mesenteric vein(SMV)was patency or partial patency.The sample t-test,nonparametric test(Mann-Whitney U test)and Chi-square test were used to statistically analyze the differences in the laboratory examination,liver function Child-Pugh classification,etiology classification,previous surgical history,surgical success rate,incidence of complications,the number of intraoperative puncture needles,the usage quantities of stents,the number of balloons used,the length of shunt,the duration of simple establishment of shunt,the total duration of surgery,the pressure of superior mesenteric vein before and after the establishment of shunt,the number of days in hospital,the cost of surgery and other related indicators between the TIPS group and the TEPS group.The Kaplan-Meier survival curve was used to calculate the cumulative shunt patency rate,the recurrence rate of postoperative portal hypertension,the incidence of hepatic encephalopathy and the survival rate between the two groups.Results:A total of 90 patients with PHT with CTPV were enrolled in this study,and all patients completed laboratory examinations and or computerized tomographic venography of the portal vein-superior mesenteric vein(CTV)or magnetic resonance venography(MRV).56 patients were enrolled in the TIPS group and 34 patients in the TEPS group(13 patients were treated with TEPS after previous TIPS failed).There were significant differences in the surgical success rate(100.00%vs.73.21%)and surgical complication rate(5.88%vs.36.59%)between TEPS group and TIPS group(X~2=10.929,9.996,all P<0.05).In the two groups,the shunt establishment time[30.50(21.00～56.00)min vs.92.00(43.00～209.00)min],the total duration of surgery[152.50(70.00～210.00)min vs.190.00(110.00～350.00)min],the number of puncture needles during operation[1(1～3)stitches vs.(5～28)stitches],the number of stents used[1(1～2)stents vs.2(1～3)stents],the length of the shunt[10(7～13)cm vs.15(12～22)cm],the cost of operation[9.02(6.96～11.18)ten thousand yuan vs.9.86(7.06～15.14)ten thousand yuan],The differences were all statistically significant(Z=-7.330,-3.677,-7.602,-5.667,7.221,-5.667,all P<0.05).After operation,the pressure of superior mesenteric vein in TEPS group decreased from(29.83±2.70)mm Hg to(16.04±2.59)mm Hg in the TEPS group and and that in TIPS group decreased from(30.76±3.21)mm Hg(1 mm Hg=0.133k Pa)to(16.19±3.56)mm Hg,both with statistical significance(t=21.494,19.476,both P<0.01).The superior mesenteric vein pressure before and after the shunt channel was established in the two groups were[(30.76±3.21)mm Hg vs.(29.83±2.70)mm Hg]and[(16.19±3.56)mm Hg vs.(16.04±2.59)mm Hg],respectively,and the difference was not statistically significant(t=1.341,0.202,P=0.184,0.841).There was no significant difference in the absolute decrease of superior mesenteric vein pressure after the establishment of shunt in the two groups[(14.23±2.04)mm Hg vs.(13.79±2.76)mm Hg,t=0.797,P=0.428].The median follow-up time was 25(1～54)months.The median follow-up time was 25(1～54)months.The 2-year cumulative shunt patency rate(90.57%vs.72.37%)and the recurrence rate of portal hypertension symptoms(6.07%vs.25.50%)in the TEPS group and the TIPS group were statistically significant(all P<0.05).There were no statistically significant differences in the incidence of postoperative hepatic encephalopathy(HE)(16.94%vs.21.51%)and the cumulative survival rate(87.98%vs.81.81%)between the two groups(all P>0.05).Conclusion:1.TEPS is safe and effective in the treatment of PHT patients with CTPV.2.Compared with TIPS,TEPS improves the success rate of surgery and shunt patency rate,reduces the incidence of complications and operation cost,and does not increase the incidence of HE.3.The best indication for TEPS is f PHT with CTPV patients who have a patent or partially patent SMV trunk.