Clinical Study On Transjugular Intrahepatic Portosystemic Stent Shunt For Portal Hypertension

ObjectiveTo evaluate the treatment of TIPS for portal hypertension,analysis of the factors affecting their efficacy and treatment.Subjects and methods112 cirrhosis patients with portal hypertension,respectively,in May 2005 to December 2008 to accept the jugular vein inferior vena cava intrahepatie portosystemic stent shunt.63 males,49 females,aged 22-78 years old(56+15 years).The main symptoms of esophageal variceal bleeding in 56 cases,25 eases of refractory ascites,gastrointestinal bleeding with 31 eases of massive ascites.Classification of liver function Child-Pugh A class of 13 eases,B-grade 76 cases, C-grade 23 cases.After observation of liver function,blood ammonia changes,bleeding esophageal varices(EGVB)control,as well as aseites subsided,and at 1 month,3 month,6 month color line abdominal vascular ultrasound,CT,MRI,angiography direct observation of the portal vein stent function,the follow-up deadline to March 30,2009.ResultsAll 112 cases of patients were received puncture and establishment of shunt successfully. Technical success rate was 100%.Mean portosystemie pressure gradients dropped from 25.6±5.6 cmH₂O to 11.2±3.3 cm H₂O The mean follow-up was 13 months(2～28 months).3 months' support for the opening rate was 97%,EGVB control rate was 98%.The incidence of postoperative hepatic encephalopathy(HE)was 16%.Short-term stent dysfunction was 1.7%, and 16%of stent dysfunction occurred in the middle or long-term. ConclusionTIPSS has a reliable and rapid effect on prevention and treatment of upper digestive tract hemorrhage caused by portal hypertension.It is conducive to the elimination of refractory ascites and improving the patients'quality of life and survival.It has very good efficacy in short-term,the incidence of postoperative hepatic encephalopathy,and liver function decrease have a certain relationship with the location of shunt establishment and the channel size.Shunt restenosis is an important factor on impact of the middle or long-term effect.Stent placement,the type of stent, and postoperative use of anticoagulant drugs affect the occurrence of the shunt restenosis. Regular follow-up has found that balloon dilatation of restenosis or re-stenting is an important tool to improve the middle or long-term effect.