Influences of combined TIPSS and modified Sugiura procedure on portal circulation and portasystemic shunt in patients with portal hypertension: 99m Tc dynamic scintigraphic study

Objectives: The purpose of this study was to determine the influences of combined TIPSS and modified Sugiura procedure on portal circulation and portasystemic shunt in patients with portal hypertension and to assess the therapeutic efficacy of this combined therapeutic protocol. Methods: Fourteen patients with portal hypertension and oesophageal varices underwent the combined treatment of TIPSS and modified Sugiura procedure and were entered into the study that included routine 99m Tc dynamic scintigraphy, direct portal venous pressure measurement. Results: The initiating developing time of liver and portal vein were brought forward from (58.67±13.71) seconds and (53.33±10.82) seconds to (43.11±8.43) seconds and (39.56±8.59) seconds( P 0.01) after TIPSS, respectively. The SI (shunt index), (87.36±6.25)% before TIPSS, decreased to (75.30±6.99)%( P 0.01). Portal pressure decreased from (42.89±3.33)cmH 2O to (34.00±2.65)cmH 2O( P 0.001). After modified Sugiura procedure, the initiating developing time of liver and portal vein moved up significantly, while SI remained no change. The average slope of hepatic time radioactivity curves increased to 4.82±3.17( P 0.01). The portal pressure decreased further more. The hepatic function did not change significantly. Conclusions: TIPSS reduces SI effectively and improves the portal circulative situations, the modified Sugiura procedure increases the portal hepatopetal blood flow, which preserves the high velocity of blood flow in intrahepatic shunt pathway. The influences of combined TIPSS and modified Sugiura procedure on portal circulation and portasystemic shunt are beneficial.And this combined protocol can reliably enhance the clinical therapeutic efficacy on portal hypertension.