Association between portal vein pressure drop gradient after transjugular intrahepatic portosystemic shunt and clinical prognosis

Objective To investigate the association between portal vein pressure drop gradient in patients with cirrhotic portal hypertension treated by transjugular intrahepatic portosystemic shunt( TIPS) and clinical prognosis,as well as the ideal range of portal vein pressure drop. Methods A total of 58 patients who underwent TIPS in Xinqiao Hospital of Third Military Medical University from November 2013 to December 2015 were enrolled. All the patients underwent TIPS and embolization of the gastric coronary vein and the short gastric veins,and the change intervals of portal vein pressure gradient were monitored. The follow- up time ranged from 3 days to 2 years,and the association of portal vein pressure drop gradient with postoperative liver function,splenic function,rebleeding rate,hepatic encephalopathy,and portal hypertensive gastrointestinal diseases was analyzed. The paired t- test was used for comparison of parameters before and after treatment. Results The patients had a significant reduction in liver function on day 3 after surgery. At 2 month after surgery,the levels of TBil was rised and had significant changes[( 49. 81 + or - 27. 82) [mu]mol/L vs( 31. 64 + or - 17. 67) [mu]mol/L,t = 5. 372,P 0. 001]. At 6 months after surgery,red blood cell count and platelet count had no significant changes,but,white blood cell count was reduced[( 3. 79 + or - 1. 37) x10~9/L vs( 4. 57 + or -2. 24) x10~9/L,t = 2. 835,P = 0. 006]. There was a 23% reduction in portal vein pressure after surgery( from 30. 62 + or - 3. 56 mm Hg before surgery to 21. 21 + or - 2. 90 mm Hg after surgery,t = 23. 318,P 0. 001). All the patients had varying degrees of relief of gastrointestinal symptoms associated with portal vein hypertension,such as abdominal distension,poor appetite,and diarrhea. Of all patients,none experienced in- stent restenosis or occlusion and 13 experienced hepatic encephalopathy after surgery,which tended to occur at the time when postoperative portal vein pressure was reduced to 14. 7- 25. 7 mm Hg,i. e.,a 36%- 40% reduction in portal vein pressure. The results of splenic venography performed immediately after surgery showed that varicose veins almost disappeared and that there were no collateral varices. Gastroscopy was performed again within 1 month after surgery and 5 patients had no significant changes in esophageal varices. The other patients were followed up for 2 years,and the severity of esophageal and gastric varices gradually changed from severe varices wi