Objective To analyze the clinical characteristics of patients with spontaneous portalsystemic shunt and isolated gastric variceal bleeding.Methods A retrospective study was performed on the patients with spontaneous portalsystemic shunt(SPSS)and bleeding caused by isolated gastric varices type 1(IGV-1).The portal vein diameter,Hepatic Venous Pressure Gradient(HVPG),portal vein thrombosis(PVT),Child Pugh score,MELD score and treatment method of different types of SPSS patients were recorded.The patients were followed up for 3 years,and recorded the number of bleedings and their survival rate.Results A total of thirty-seven patients were included in this study,including 15 patients with splenorenal shunt,14 patients with gastrorenal shunt,and 8 patients with both splenorenal shunt and gastrorenal shunt.During the follow-up period of time,within 18 patients who were treated with transjugular intrahepatic portosystomic stent shunt(TIPS),4 cases(22.2％)each occured rebleeding and hepatic encephalopathy.Six cases were treated with gastric coronary vein embolization combined with partial splenic embolization.Within them,4 cases of rebleeding and 1 case of death occurred during the follow-up.Nine cases accepted endoscopic treatment.Within them,3 cases(33.3％)had rebleeding,1 patient(11.1％)had hepatic encephalopathy,and 1 case(11.1％)died during the follow-up.Univariate Cox regression analysis showed that PVT and the level of HVPG were risk factors for rebleeding.Conclusion The incidences of rebleeding,ascites and PVT in patients with SPSS and IGV-1 are high.PVT and the level of HVPG are risk factors associated with rebleeding.The form of shunt has important value for the selection of IGV-1 treatment options.
维普
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