vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2024-2-16-27vtio-1766Research ArticleКлиническая трансплантологияClinical TransplantologyТрансъюгулярное внутрипеченочное портосистемное шунтирование или комбинация неселективных β-блокаторов с эндоскопическим лигированием варикозных вен пищевода в целях профилактики кровотечений у больных циррозом печени, ожидающих трансплантациюTransjugular intrahepatic portosystemic shunt or a combination of nonselective beta blockers and endoscopic variceal ligation for prophylaxis of bleeding in waitlisted cirrhotic patientsКоробкаР. В.KorobkaR. V.

Ростов-на-Дон

Rostov-on-Don

roman_korobka@icloud.ruГотьеС. В.GautierS. V.

Москва

Moscow

gautier@list.ruХоронькоЮ. В.KhoronkoYu. S.

Ростов-на-Дону

Rostov-on-Don

khoronko507@gmail.ruПасечниковВ. Д.PasechnikovV. D.

Пасечников Виктор Дмитриевич

355017, Ставрополь, ул. Авиационная, 21

Тел. (962) 447-75-13

Victor Pasechnikov

21, Aviatsionnaya str., Stavropol, 355017

Phone: (962) 447-75-13

passetchnikov@mail.ruСапроноваН. Г.SapronovaN. G.

Ростов-на-Дону

Rostov-on-Don

sapronovang@yandex.ruПоршенниковИ. А.PorshennikovI. A.

Новосибирск

Novosibirsk

porshennikov@mail.ruМалеванныйМ. В.MalevannyM. V.

Ростов-на-Дону

Rostov-on-Don

doctorm.m@mail.ruПакЕ. С.PakE. S.

Ростов-на-Дону

Rostov-on-Don

Katya_pack-k@mail.ruПасечниковД. В.PasechnikovD. V.

Ставрополь

Moscow

spicher@mail.ruГБУ Ростовской области «Ростовская областная клиническая больница»; ФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава РоссииРоссияRostov Regional Clinical Hospita; Rostov State Medical UniversityRussian FederationФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России; ФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. Сеченова Минздрава России (Сеченовский университет)Russian FederationShumakov National Medical Research Center of Transplantology and Artificial Organs; Sechenov UniversityRussian FederationФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава РоссииРоссияRostov State Medical UniversityRussian FederationГБУ Ростовской области «Ростовская областная клиническая больница»; ФГБОУ ВО «Ставропольский государственный медицинский университет» Минздрава РоссииРоссияRostov Regional Clinical Hospital; Stavropol State Medical UniversityRussian FederationГБУЗ Новосибирской области «Государственная Новосибирская областная клиническая больница»; ФГБОУ ВО «Новосибирский государственный медицинский университет» Минздрава РоссииРоссияNovosibirsk Regional Clinical Hospital; Novosibirsk State Medical UniversityRussian FederationФГБОУ ВО «Ставропольский государственный медицинский университет» Минздрава РоссииРоссияSechenov UniversityRussian Federation2024160220242621627Copyright © Коробка Р.В., Готье С.В., Хоронько Ю.В., Пасечников В.Д., Сапронова Н.Г., Поршенников И.А., Малеванный М.В., Пак Е.С., Пасечников Д.В., 20242024Коробка Р.В., Готье С.В., Хоронько Ю.В., Пасечников В.Д., Сапронова Н.Г., Поршенников И.А., Малеванный М.В., Пак Е.С., Пасечников Д.В.Korobka R.V., Gautier S.V., Khoronko Y.S., Pasechnikov V.D., Sapronova N.G., Porshennikov I.A., Malevanny M.V., Pak E.S., Pasechnikov D.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/1766Цель

Цель: обоснование выбора оптимального метода профилактики и снижения риска кровотечений из варикозных вен пищевода (ВВП) и кардии у больных с декомпенсированным циррозом печени, включенных в лист ожидания трансплантации печени (ТП).

Материалы и методы

Материалы и методы. Пациентам с резистентным и не резистентным к терапии диуретиками асцитом проведена профилактика повторных кровотечений посредством TIPS или комбинации ЭЛ + НСББ.

Результаты

Результаты. Количество лейкоцитов, уровень концентрации Na и выраженности поражений печени по классификации Child–Turcotte–Pugh (СТР) у больных с резистентным асцитом (РА) имели значимые различия при сравнении лиц, получавших комбинацию ЭЛ + НСББ или подвергшихся TIPS. У больных с не РА значимые различия были получены для количества тромбоцитов крови, концентраций альбумина и Na в крови, выраженности поражений печени по СТР при сравнении в группах ЭЛ + НСББ и TIPS. У больных с РА частота варикозных узлов (ВУ) 2-й степени, получавших ЭЛ + НСББ, была значимо выше, чем при TIPS. Частота ВУ 3-й степени была достоверно выше у больных с TIPS, чем в группе ЭЛ + НСББ. У больных с не РА частота ВУ 2-й и 3-й степени не имела значимых различий при сравнении этих показателей у пациентов обеих групп. Пропорция пациентов с классом В по СТР была значимо выше как у больных с РА, так и у отвечающих на диуретики при различных методах профилактики повторных кровотечений. Пропорции пациентов класса С по СТР при обеих формах асцита были значимо выше у пациентов группы ЭЛ + НСББ в сравнении с группой TIPS. В период ожидания ТП в течение 2 лет от начала проведения профилактики кровотечений у больных с РА повторные кровотечения развились у 78,4%, подвергшихся имплантации TIPS, а у больных группы ЭЛ + НСББ в те же сроки повторные кровотечения развились в 100% случаев. Методом Каплана–Майера с определением Log-Rank-критерия было установлено значимое различие между долями пациентов с развитием повторных кровотечений из ВУ в группах ЭЛ + НСББ или TIPS при обеих формах асцита.

Objective

Objective: to substantiate the choice of an optimal method of preventing and reducing the risk of variceal bleeding (VB) and cardia in patients with decompensated cirrhosis who have been enlisted for liver transplantation (LT).

Materials and methods

Materials and methods. Patients with diuretic-resistant and diuretic-responsive ascites underwent prophylaxis for recurrent bleeding via transjugular intrahepatic portosystemic shunt (TIPS) or a combination of endoscopic variceal ligation (EVL) and nonselective beta-blockers (NSBB).

Results

Results. Leukocyte counts, Na levels, and Child–Turcotte–Pugh (CTP) liver disease class in patients with diuretic-resistant ascites had significant differences when comparing individuals who received EVL + NSBB or underwent TIPS. In diuretic-responsive patients, there were significant differences for blood platelet count, albumin and Na levels, and CTP class when comparing EVL + NSBB and TIPS groups. In diuretic-resistant patients, incidence of grade 2 varices in EVL + NSBB group was significantly higher than in TIPS. Incidence of grade 3 varices was significantly higher in TIPS patients than in EVL + NSBB cohort. In diuretic-responsive patients, incidence of grade 2 and 3 varices had no significant differences when comparing these indicators in both groups. The proportion of patients with CTP class B was significantly higher both in diuretic-resistant and diuretic-responsive patients with various methods of rebleeding prophylaxis. The proportions of CTP class C patients with both forms of ascites were significantly higher in EVL + NSBB group than in TIPS. During the LT wait period within 2 years from the start of bleeding prophylaxis in diuretic-resistant patients, 78.4% of patients who underwent TIPS implantation developed recurrent bleeding, 100% of EVL + NSBB group within the same time frame, developed recurrent bleeding. Using the Kaplan–Meier estimate with the Log-Rank test, we were able to establish that there is a significant difference between the proportions of patients with recurrent VB in EVL + NSBB or TIPS groups with both forms of ascites.

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The authors declare that there are no conflicts of interest present.