| Objective:To explore the feasibility,safety and effectiveness of partially dilated strategy in transjugular intrahepatic portosystemic shunt(TIPS)procedure on patients with portal hypertension,and compare the clinical outcomes with completely dilated strategy TIPS.Methods:We conducted a retrospective analysis on 305 patients received TIPS procedure from March,2017 to November,2019 in our center.152 subjects were finally included through the inclusion and exclusion criteria,and they were divided into partially dilated group(8-mm stents were dilated by 6-mm balloon,n = 86)and completely dilated group(8-mm stents were dilated by 8-mm balloon,n = 66)according to the dilating degree of the stent during TIPS procedure.There was no significant difference in baseline clinical characteristics,laboratory indices and imaging features between the two groups.We observed the changes of stent diameter in partially dilated group,compared the occurrence of overt hepatic encephalopathy(OHE),variceal rebleeding,shunt dysfunction and survival in the two groups during the follow up,and performed subgroup analysis according to different indications for TIPS.In addition,the changing trends of liver and kidney function indices in the two groups were depicted and compared.Results:The technical success rates in partially dilated and completely dilated group were both 100%,and no severe complications occurred during the perioperative period.The mean values of portal pressure gradient(PPG)decreased from 26.7 ± 5.6 to 11.0 ± 3.8 mm Hg(P < 0.001)in partially dilated group,and from 27.0 ± 5.1 to 10.7 ± 2.7 mm Hg(P < 0.001)in completely dilated group,whose average decrease rate were respectively 58.8% ± 10.9% and 59.5% ± 10.7%(P=0.692).During the follow up,the cumulative rate of OHE in partially dilated and completely dilated group respectively 3,6,12,24 months after TIPS procedure were 12.8 ± 3.6% vs.24.2 ± 5.3%,14.1 ± 3.8% vs.27.5 ± 5.5%,14.1 ± 3.8% vs.29.6 ± 5.7%,14.1 ± 3.8% vs.29.6 ± 5.7%(HR=0.461,95%CI=0.226-0.940,Log rank P=0.029).The independent risk factors for OHE found by univariate and multivariate analysis were age(HR=1.050,95%CI=1.009-1.092,P=0.015),Child-Pugh score(HR=1.462,95%CI=1.141-1.874,P=0.003)and grouping(HR=0.319,95%CI=0.132-0.773,P=0.011).After ROC analysis,based on the calculation of maximum Youden index,the cutoff value of age and Child-Pugh score were 50.5 and 8.5 respectively.There was no statistical difference in the cumulative rate of variceal rebleeding,shunt dysfunction and survival between the two groups,and no statistical difference was found in dynamic changes of liver function between the two groups.Conclusion:1.The partially dilated TIPS could reduce the incidence of OHE compared with completely dilated TIPS.2.The patients with age > 50.5 years old and Child-Pugh score ≥ 8 are at greater risk of developing hepatic encephalopathy,partially dilated TIPS seem to be more applicable for them.3.The partially dilated TIPS had similar effects as completely dilated TIPS and did not increase the risk of shunt dysfunction and death. |
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