| Objiective:To explore the effect of Transjugular intrahepatic portosystemic shunt(TIPS)on hypersplenism and TIPS combined with partial splenic embolization(PSE)for the treatment of cirrhosis and portal hypertension and upper gastrointestinal bleeding with spleen The safety and clinical value of hypertensive patients.Methods:1.A retrospective collection of 377 patients who underwent TIPS for the diagnosis of liver cirrhosis,portal hypertension and upper gastrointestinal hemorrhage combined with hypersplenism in the First Affiliated Hospital of Kunming Medical University from October 2014 to October 2019.The screening data was complete and met the enrollment conditions.165 patients were divided into group A(mild),group B(moderate)54 cases,and group C(severe)48 cases according to the degree of hypersplenism.Leukocytes were collected at 7 days,1 month,6 months,and 1 year after surgery.(WBC),red blood cell(RBC)and platelet(PLT)values,observe the effect of TIPS on different degrees of hypersplenism;2.Collect 54 patients with severe hypersplenism at the same time,and divide them into TIPS combined with PSE according to whether they are undergoing PSE(I)Group)28 cases and TIPS(group II)26 cases.The blood routine,liver function,immune index,stent patency and complication rate were analyzed and compared between the two groups.Results:1.Blood picture changes in groups A,B,and C at each time period after TIPS Group A:The values of WBC and PLT of patients within 1 month after TIPS showed a short-term increase trend compared with the value before operation,and reached the peak in January(t=-2.330,-2.702;P<0.05),and each time after 1 month.The period basically restored to the preoperative level(P>0.05)and remained stable,Group B:The WBC and PLT values of moderate patients basically maintained the preoperative level within 1 year after TIPS(P>0.05);Group C:In patients with severe hypersplenism,there was no significant difference in the value of each time period in the first month after the operation.The WBC and PLT levels in June and the first year showed a decreasing trend(P<0.05);There was no statistically significant difference in RBC between the three groups in each time period after operation compared with that before operation(P>0.05).2.Changes of liver function indexes in groups I and II at various periods after operationGroup Ⅰ:One week after operation:liver function indexes such as TBIL,PT,ALT,AST,and Child-Pugh score were significantly improved compared with preoperative(P value less than 0.05);One month after the operation:TBIL and PT were higher than before the operation(P values were all less than 0.05),and the remaining liver function indexes(ALT,AST)and Child-Pugh score returned to normal levels compared with 1 week after the operation;From three months to six months after operation:liver function indexes such as TBIL,PT,ALT,AST and Child-Pugh score did not change significantly from the preoperative level(P>0.05);One year after operation:The liver function indexes(TBIL,ALB,AST,ALT,PT)were not significantly changed from the preoperative level(P>0.05),but there were differences in the Child-Pugh scores of liver function between the A and B groups(t=2.331,P=0.037);Group Ⅱ:One week after operation:liver function indexes such as TBIL,PT,ALT,AST and Child-Pugh score were significantly improved compared with preoperative(P value less than 0.05);compared with group I,there was a statistically significant difference in Child-Pugh score of liver function Meaning(t=-0.901,P=0.037);One month after the operation:TBIL and PT were higher than before the operation(P values were all less than 0.05),and the remaining liver function indexes(ALT,AST)and Child-Pugh score returned to normal levels compared with 1 week after the operation;From three months to six months after operation:liver function indexes such as TBIL,PT,ALT,AST and Child-Pugh score did not change significantly from the preoperative level(P>0.05);One year after operation:the liver function indexes(TBIL,ALB,AST,ALT,PT)and the Child-Pugh score of liver function did not change significantly from the preoperative level(P>0.05),but compared with group Ⅰ Child-Pugh score There is a difference in Pugh score(t=2.331,P=0.037);3.Changes in blood cell levels of patients in groups Ⅰ and Ⅱ at various times after operationGroup I:WBC and PLT levels increased significantly in each time period after surgery,and reached their peak in January after surgery(t=0.711;0.693,P<0.01).Group I was 1 week,1 month,half a year,1 month after surgery.In 2015,WBC and RBC were significantly higher than the level of group II,and the difference was statistically significant(P<0.05);but no significant changes were observed in the RBC levels of the two groups after surgery;Group II:There was a decreasing trend from six months to one year after surgery(P<0.05),and there was no statistically significant difference in the rest of the time compared with before surgery(P>0.05);4.Changes of immune indexes at various postoperative periods and their correlation with liver functionGroup I:IgA,IgM,and IgG increased significantly in January after surgery(t=-2.416,-1.903,-5.169;P=0.023,0.000,0.000),and there was a statistically significant difference in the increase compared with group Ⅱ(P<0.05);Th1/Th2 secretion of cytokines(IL-2,IL-10)in various time periods after surgery were not statistically significant(P>0.05);preoperative IL-6 was higher than the normal range,And increased significantly on the 3rd and 1st week after operation(P<0.01),and significantly higher than that of group Ⅱ(t=3.217,3.601;P=0.000,0.000);1 month after operation,IL-6 of group Ⅰ It is still higher than the preoperative level(r=-1.274;P=0.031);IL-8 in group I was observed to be higher than that before the operation 1 week after the operation(t=-1.308,P=0.029),and the preoperative level was restored after 1 month Level(P>0.05).At 3 months,6 months and 1 year after surgery,the above indicators all fell back to the preoperative level(P>0.05);1 week after surgery,the lymph factor IL-6 was positively correlated with TBIL,AST and PT(r=0.603,0.714,1.217;P<0.05);IL-8 was positively correlated with ALT and PT(r=0.801,1.217;P<0.05);at the same time,IL-6 was found to be positively correlated with IL-8(r=0.655;P<0.05);Group II:The difference in IgA,IgM and IgG in each postoperative period was not statistically significant compared with preoperative period(P>0.05).The difference in Thl/Th2 secretion of cytokines(IL-2,IL-10)in each postoperative period was higher than that before operation.There was no statistical significance(P>0.05).The preoperative IL-6 was higher than the normal range,and it increased significantly on the 3rd day and 1 week after the operation(P<0.01);3 months,6 months and 1 month after the operation At the end of the year,the above-mentioned indicators all fell back to the preoperative level(P>0.05);5.Changes of portal vein diameter,blood flow velocity in portal vein and shunt in patients in groups Ⅰ and Ⅱ at various times after operationThere was no statistically significant difference in the internal diameter of the portal vein between the two groups at 1 month,3 months,6 months and 1 year after the operation(P>0.05);however,the two groups had no significant difference in the main portal vein after each time period.The blood flow velocity was increased compared with that before the operation(P<0.05),and the numerical difference between the two groups in each time period Ⅰ and Ⅱ was significantly different(P<0.05);the portal blood flow velocity in each period after the operation in group Ⅰ was significantly faster than that Group Ⅱ(P<0.05);6.Postoperative complications of the two groups of patientsBy the end of the 1-year follow-up period,there were no deaths.A total of 7 cases of hepatic encephalopathy(5 cases of grade Ⅰ and 2 cases of grade Ⅱ)occurred in groupⅡ within 1 year after the operation.They were given oral lactulose and intravenous drip of ornithine aspartate.Improvement after injection and other treatments),8 cases of stent dysfunction(2 cases of complete failure,6 cases of stenosis),5 cases of recurrence of melena and hematemesis(symptoms relieved after shunt correction or/and auxiliary GCVE);In the same follow-up period,6 cases of hepatic encephalopathy(5 cases of grade Ⅰ,1 case of grade Ⅲ,alleviated after treatment with the above-mentioned drugs and vinegar enema),8 cases of stent dysfunction(1 case of complete loss)occurred in the same follow-up period.7 cases of stenosis),6 cases of black stool and hematemesis recurred(symptoms were relieved after the same treatment as in group Ⅱ),and no cases of splenic abscess.There was no significant difference in postoperative complications and the degree of remission of esophageal and gastric varices between the two groups(P>0.05).The remaining abdominal pain,fever,vomiting and poor appetite were all relieved after symptomatic treatment.Conclusions:1.TIPS can improve short-term hypersplenism in patients with mild hypersplenism,but cannot improve moderate to severe hypersplenism;2.TIPS combined with PSE is safe,can effectively control bleeding and relieve hypersplenism,and improve liver function and immune function;3.Both TIPS and PSE can cause short-term transient damage to liver function,which can be gradually recovered in about 1 month.TIPS and PSE are recommended to be performed after 1 month;4.TIPS combined with PSE can improve hypersplenism,and improve liver function and immune function to a certain extent;the changes in serum levels of IL-6 and IL-8 have certain guidance for the judgment of liver function;5.After TIPS combined with PSE,the blood flow velocity in the main portal vein and shunts is accelerated,and the incidence of thrombosis in the portal vein and shunts is not increased. |
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