经颈静脉肝内门体分流术联合部分脾动脉栓塞术治疗肝硬化并发门脉高压症患者门静脉血流动力学变化研究*

doi:10.3969/j.issn.1672-5069.2025.01.031

Abstract

Abstract: Objective The aim of this study was to investigate portal vein hemodynamic changes in patients with liver cirrhosis (LC) and portal hypertension (PH) after transjugular intrahepatic portal shunting (TIPS) and partial splenic artery embolization (PSE). Methods 100 patients with LC complicated with PH were encountered in First Affiliated Hospital, Guangdong Medical University and Comprehensive Interventional Department, Henan Provincial People's Hospital between January 2021 and December 2023, and were randomly divided into control (n=47) and observation group (n=53), and all patients in the two groups underwent TIPS and those in the observation received PSE after TIPS. All patients were followed-up for one year. Plasma endothelin (ET), angiotensin II (AT II) and renin activity (PRA) levels were assayed by ELISA, and portal vein diameter ( PVD), portal venous flow (PVF), splenic vein diameter(SVD) and splenic vein flow (SVF) were detected by ultrasonography. Results After treatment, peripheral white blood cell, platelet and red blood cell counts in the observation group were (5.9±0.8)×10⁹/L, (93.7±14.0)×10⁹/L and (3.5±0.6)×10¹²/L, all significantly higher than [(3.4±0.4)×10⁹/L, (64.9±11.2)×10⁹/L and (3.1±0.2)×10¹²/L, respectively, P＜0.05] in the control; plasma ET, ATⅡ and PRA levels were (54.9±5.8)ng/L, (113.7±1.0)ng/L and (69.5±6.1)ng/L, all significantly lower than [(79.4±6.4)ng/L, (144.9±1.2)ng/L and (98.2±7.0)ng/L, respectively, P＜0.05] in the control; PVD, SVD and SVF in the observation were (12.1±3.0)mm,(9.4±0.6)mm and (275.9±37.6)ml/min, all significantly smaller or lower than [(13.5±2.2)mm, (10.5±0.4)mm and (301.1±43.8)ml/min, respectively, P＜0.05] in the control; by end of one-year follow-up, incidences of shunt stenosis or occlusion, esophageal varice bleeding (EVB) and hepatic encephalopathy in the control group were 19.2%, 2.1% and 25.5%, and they were 17.0%, 0.0% and 15.1% in the observation group. Conclusion Combination of TIPS and PSE in dealing with patients with LC-induced PH could improve hypersplenism and reduce the risk of EVB, and we remind importance of surveillance of shunt patency.

Key words: Liver fibrosis, Portal hypertension, Transjugular intrahepatic portosystemic shunt, Partial splenic artery embolization, Portal venous hemodynamics, Therapy

Wang Wendong, Liang Maoquan, Liu Yuyan. Portal vein hemodynamic changes in patients with liver cirrhosis and portal hypertension after transjugular intrahepatic portal shunting and partial splenic artery embolization[J]. Journal of Practical Hepatology, 2025, 28(1): 120-123.

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Portal vein hemodynamic changes in patients with liver cirrhosis and portal hypertension after transjugular intrahepatic portal shunting and partial splenic artery embolization

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