CLINICAL COMPARISON OF TWO SURGICAL PROCEDURES IN THE TREATMENT OF UPPER GASTROINTESTINAL HEMORRHAGE SECONDARY TO CIRRHOSIS PORTAL HYPERTENSION

Zhen Yang^{1, 2, #}, Li Feng^{3, #}, Xue Yao², Zhong Chen², Xiquan Zhang^{2, 4, *}

¹School of Medical Imaging, Weifang Medical University, Weifang, Shandong, 261000, PR China - ²Department of Interventional Vascular, Zibo 148 Hospital, China RongTong Medical Health Care Group Co. Ltd., Zibo, Shandong, 255300, PR China - ³Department of Radiology, Zibo Maternal and Child Health Care Hospital, Zibo, Shandong, 255300, PR China - ⁴Department of Interventional Vascular, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, 261000, PR China

Objective: To explore the differences of clinical efficacy and safety between transjugular intrahepatic portosystemic shunt (TIPS) assisted by gastric coronary embolization and TIPS alone in the treatment of upper gastrointestinal bleeding secondary to portal hypertension in liver cirrhosis.

Methods: 78 patients with upper gastrointestinal bleeding secondary to portal hypertension in liver cirrhosis admitted to our hospital from January 2019 to June 2021 were retrospectively included. Among them, 35 cases were treated with TIPS alone (control group) and 43 cases were treated with TIPS assisted by gastric coronary embolization (observation group). The incidence of postoperative rebleeding, preoperative and postoperative portal hemodynmic indexes, liver function indexes, coagulation function indexes and the incidence of complications were compared between two groups.

Results: The incidence of rebleeding in the observation group 6 and 12 months after surgery was significantly lower than that in the control group (P<0.05). The levels of albumin, total bilirubin and prothrombin time in the observation group 12 months after surgery were significantly better than those in the control group and before surgery (P<0.05). There was no significant difference between two groups in the incidence of fever and abdominal pain (P>0.05). The incidence of hepatic encephalopathy in the observation group was significantly lower than that in the control group (P<0.05).

Conclusion: Compared with TIPS surgery alone, TIPS assisted by gastric coronary embolization can effectively reduce the risk of rebleeding, improve liver function and blood coagulation, without affecting portal haemodynamics, and help prevent the occurrence of hepatic encephalopathy in the treatment of upper gastrointestinal bleeding secondary to portal hypertension in liver cirrhosis.