Objective: To compare the safety and efficacy of transmesenteric vein extrahepatic portosystemic shunt (TEPS) and transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of cavernous transformation of the portal vein (CTPV). Methods: The clinical data of CTPV patients with patency or partial patency of the superior mesenteric vein treated with TIPS or TEPS treatment in the Department of Vascular Surgery of Henan Provincial People's Hospital from January 2019 to December 2021 were selected. The differences in baseline data, surgical success rate, complication rate, incidence rate of hepatic encephalopathy, and other related indicators between TIPS and TEPS group were statistically analyzed by independent sample t-test, Mann-Whitney U test, and Chi-square test. Kaplan-Meier survival curve was used to calculate the cumulative patency rate of the shunt and the recurrence rate of postoperative portal hypertension symptoms in both groups. Results: The surgical success rate (100% vs. 65.52%), surgical complication rate (6.67% vs. 36.84%), cumulative shunt patency rate (100% vs. 70.70%), and cumulative symptom recurrence rate (0% vs. 25.71%) of the TEPS group and TIPS group were statistically significantly different (P < 0.05). The time of establishing the shunt [28 (2141) min vs. 82 (51206) min], the number of stents used [1 (12) vs. 2 (15)], and the length of the shunt [10 (912) cm vs. 16 (1220) cm] were statistically significant between the two groups (t = -3.764, -4.059, -1.765, P < 0.05). The incidence of postoperative hepatic encephalopathy in the TEPS group and TIPS group was 6.67% and 15.79% respectively, with no statistically significant difference (Fisher's exact probability method, P = 0.613). The pressure of superior mesenteric vein decreased from (29.33 ± 1.99) mmHg to (14.60 ± 2.80) mmHg in the TEPS group and from (29.68 ± 2.31) mmHg to (15.79 ± 3.01) mmHg in TIPS group after surgery, and the difference was statistically significant (t = 16.625, 15.959, P < 0.01). Conclusion: The best indication of TEPS is in CTPV patients with patency or partial patency of the superior mesenteric vein. TEPS improves the accuracy and success rate of surgery and reduces the incidence of complications.
目的： 对比分析经肠系膜上静脉肝外门体分流术（TEPS）与经颈静脉肝内门体分流术（TIPS）在门静脉海绵样变（CTPV）治疗中的安全性和有效性。 方法： 选择2019年1月至2021年12月就诊于河南省人民医院血管外科接受TIPS或TEPS治疗的肠系膜上静脉主干通畅或部分通畅的CTPV患者临床资料，采用独立样本t检验、Mann-Whitney U检验检验、卡方检验进行统计学分析TIPS组和TEPS组患者基线资料、手术成功率、并发症发生率、肝性脑病发生率等相关指标的差异；并采用Kaplan-Meier生存曲线计算两组累计分流道畅率和术后门静脉高压症状复发率。 结果： TEPS组与TIPS组手术成功率（100%比65.52%）、手术并发症发生率（6.67%比36.84%）、累计分流道通畅率（100%比70.70%）、累计症状复发率（0比25.71%），差异均有统计学意义（P值均<0.05）。两组建立分流道时间[28（21~41）min比82（51~206）min]、支架使用数量[1（1~2）枚比2（1~5）枚]、分流道长度[10（9~12）cm比16（12~20）cm]，差异均有统计学意义（t = -3.764、-4.059、-1.765，P值均<0.05）。TEPS组及TIPS组术后肝性脑病发生率分别为6.67%与15.79%，差异无统计学意义（Fisher确切概率法，P = 0.613）。TEPS组术后肠系膜上静脉压力从（29.33±1.99）mmHg降至（14.60±2.80）mmHg，TIPS组从（29.68±2.31）mmHg降至（15.79±3.01）mmHg，差异均有统计学意义（t = 16.625、15.959，P值均<0.01）。 结论： TEPS最佳适应证是肠系膜上静脉主干通畅或部分通畅的CTPV患者。TEPS提高了手术的精准性及成功率、降低了并发症发生率。.
Keywords: Cavernous transformation of the portal vein; Portal Hypertension; Transjugular intrahepatic portosystemic shunt; Transmesenteric vein extrahepatic portosystemicshunt.