Effects of transjugular intrahepatic portosystemic shunt combined with left gastric vein embolization on the liver function of patients with liver cirrhosis

Abstract

Objective To compare the difference in the effects on liver function between transjugular intrahepatic portosystemic shunt (TIPS) alone and the combination of TIPS and left gastric vein embolization (LGVE) in patients with liver cirrhosis. Methods This research was a retrospective study. From September 2014 to September 2015, 31 patients with liver cirrhosis underwent TIPS (TIPS group) and 29 patients with liver cirrhosis underwent TIPS combined with LGVE (TIPS+ LGVE group) were enrolled. The data of the liver function of patients before and after operation were collected and the Child-Pugh score and model for end-stage liver disease (MELD) were also calculated. Student's t test and chi-squared test were performed for statistical analysis. Results The preoperative portal vein pressures of TIPS group and TIPS+ LGVE group were (28.48±2.77) mmHg (1 mmHg=0.133 kPa) and (28.38±2.92) mmHg, respectively. And after operation, the portal vein pressures decreased to (17.81±1.47) mmHg and (17.97±2.04) mmHg, respectively, and the differences were both statistically significant (t=18.908 and 11.648, both P<0.01). At 12 months after operation, Child-Pugh score of TIPS+ LGVE group was 5.69±1.19, which was significantly lower than that before operation (7.03±1.76), and the difference was statistically significant (t=3.398, P=0.001), which was also lower than that of TIPS group at the same time point (6.52±1.54), and the difference was statistically significant (t=2.303, P=0.025). At 12 months after operation, the component ratio of patients with Child-Pugh grade A of TIPS+ LGVE group was 89.7% (26/29), which was higher than that before operation (44.8%, 13/29), and the difference was statistically significant (χ2=13.228, P<0.01). The component ratio of patients with Child-Pugh grade B was 6.9%(2/29), which was lower than that before operation (41.4%, 12/29), and the difference was statistically significant (χ2=9.416, P<0.01). Conclusions TIPS significantly reduces portal vein pressure in patients with liver cirrhosis and it does not deteriorate liver function of patients in the long term. The combination of TIPS and LGVE is better than TIPS alone in improving liver function in patients with liver cirrhosis, especially in improvig long-term liver function in patients of Child-Pugh A and B grade. Key words: Portasystemic shunt, transjugular intrahepatic; Left gastric vein embolization; Variceal bleeding; Liver cirrhosis; Liver function