Results of a personalized approach to surgical correction of portal hypertension in patients with liver cirrhosis

Abstract

Objective: to improve the results of treatment of patients with complicated intrahepatic portal hypertension by developing optimal surgical treatment tactics and choosing drug correction aimed at preventing thrombotic venous complications.Materials and methods: 82 patients with clinically significant portal hypertension of cirrhotic origin were examined and treated. The I group consisted of 24 patients who underwent transjugular intrahepatic portosystemic stent bypass surgery, the II group included 58 patients for whom the operation was supplemented with selective embolization of the gastric veins. Methods: clinical and laboratory examination, “Thrombodynamics” test using a “prognostic calculator” (RF patent), surgical, statistical.Results: it was established that 26,8% of patients had a risk of developing venous thrombotic complications: in group I 4/24 (16,6%), in group II — 18/58 (31,0%). Personalized drug correction carried out in the postoperative period led to the absence of risk in 2/22 (9,1%) patients in group I and in 8/53 (15,1%) in group II. The number of deaths in group I was 2/24 (8,33%) and in group II 5/58 (8,62%). Shunt thrombosis was detected in 3/22 (13,63%) patients of group I and in 1/53 (1,88%) patients of group II in the period from 24 to 32 months after surgery. Varicose esophageal-gastric bleeding occurred in 2/22 (9,00%) patients with shunt thrombosis of group I and in 1/53 (1,88%) of group II patients who underwent endoscopic ligation of esophageal varices.Conclusion: a method for predicting the risk of developing thrombotic complications in patients with liver cirrhosis is a convenient tool for risk stratification of patients. An individual approach ensures monitoring of the patient not only before, but also after the operation. Drug correction regimens for identifying high, moderate and low risks of complications made it possible to prevent them. TIPS surgery alone and in combination with selective embolization of gastric veins allows achieving comparable results in observation groups against the background of corrective therapy.

Keywords

• liver cirrhosis
• portal hypertension
• tips
• surgical treatment
• gastric vein embolization