A comparison of efficacies between transjugular intrahepatic portosystemic shunt versus portoazygos devascularization in the treatment of portal hypertension with variceal bleeding

Objective To compare the efficacies between transjugular intrahepatic portosystemic shunt (TIPS) and portoazygos devascularization (PAD) in the treatment of portal hypertension with variceal bleeding.Methods From December 1993 to December 2010,309 patients with portal hypertension and variceal bleeding were admitted. According to their general conditions and Child-Pugh grades,they were assigned to undergo TIPS ( group A,n =235 ) or PAD ( group B,n =74).Before operation,compared with the PAD group,the TIPS group possessed worse liver functions,more severe ascites and a greater frequency of bleeding. After operation,the therapeutic efficacies and changes of portal hemodynamics,recurrent variceal bleeding,post-operative encephalopathy and long-term survival were evaluated between two groups.Results The postoperative portal pressure in the TIPS group ( (42.6 ± 7.0) vs (26.3 ± 4.1 ) cm H2O )decreased much more than that in the PAD group( (38.7 ±5.2) vs (33.5 ±5.8) cm H2O,P ＜0.01 ).The rebleeding rates during early postoperation were 0.85％ (2/235) and 6.76％ (5/74) in TIPS and PAD groups respectively,the occurring rates of hepatic encephalopathy 4.68％ ( 11/235 ) and 4.05％ (3/74) and the rates of operative mortality 1.70％ (4/235) and 6.76％ (5/74) respectively.Survival rates of 1,3,5and 10 years were 98.30％ (231/235) vs 92.24％ ( 69/74 ),92.41％ ( 146/158 ) vs 88.06％ ( 59/67 ),80.77％ (84/104) vs 79.25％ (42/53),51.43％ (36/79) vs 51.85％ (14/27) in TIPS and PAD groups respectively.Conclusions As compared with PAD,TIPS offers the such advantages as less trauma,wider indication,faster hemostasis and satisfactory therapeutic efficacies.Especially for the emergency treatment of a patient with massive variceal bleeding and Child-Pugh C grade liver function,TIPS is a better option than PAD. Key words: Hypertension,portal; Esophageal and gastric varices; Portosystemic shunt,transjugular intrahepatic; Portoazygos devascularization