The Study On Clinic Effects Of TIPS Combines With PSE In The Treatment Of Portal Hypertension And Hypersplenism

Background and aimPortal hypertension is very common in clinical, bleeding from portal hypertension, primarily from esophagogastric varices, remains a major medical problem, resulting in substantial morbidity and mortality as well as extensive resource expenditures. UP to now, numerous treatments for portal hypertensive bleeding are available, each with advantages as well as significant side effects or complications, with the choice of therapy being dependent on the patient's physiologic status and medical compliance. The popular methods are endoscopic and medical conservative treatment, or surgical method. Transjugular intrahepatic portalsystemic shunt (TIPS) is a safe interventional method which could reduce portal hypertension. Partial spleen embolization is an effective method of treating hypersplenism, now widely used in clinical. The aim of this article is to evaluate the therapeutic effects of these two methods.Materials and methods(1) Collect the patients'data of cirrhotic portal hypertension from January 2004 to march 2008 in Southwest Hospital of Third Military Medical University, who underwent TIPS. The data included: patients'name, sex, age, basically reasons of hepatitis, operation date, past history, bleeding history, physical examination, endoscopic examination, the peripheral hemocytology of per-operation of post-operation, 1day, 7days, 14days, 30days, 60days, and liver function, renal function, blood coagulating, operation condition, the decrease of portal hypertension, and so on. At the same time, we collected the patients'data that underwent surgical method of esophagogastric devascularization combined with splenectomy (EGDS), follow-up the patients'recent situations by telephone. (2) Collect the patients'blood, test the blood ammonia, endotoxin, and test the spleen function. (3)To compare the applicability between model for end-stage liver disease (MELD) and Child-Turcott-Pugh (CTP) on predicting the the patients who undergoing TIPS. Data of all patients were analyzed retrospectively. The main statistical tests included: Kaplan-Merier analysis to compare survival respectively, and the area of ROC to compare the performance of the two models for predicting 3-month, 1-year, and 2-years mortality.Results(1) Portosystemic gradient decreased significantly after TIPS, from 29.8±3.2mmHg to 17.4±0.7mmHg. ALT,Alb on postoperative were improved. AST,TBIL,DBIL on postoperative were higher than before, however were decreased during the follow-up. And the renal function was also improved. The ammonia, endotoxin were improved after operation. During the follow-up, the rate of rebleeding was 9.3%, encephalopathy was 10.4%. Severe hepatitis was occurred in 2 patients, and shunt abnormalities in 12 patients.(2) There was no significant difference between the two groups in clinical data before operation. After operation, leukocyte and platelet count kept significantly higher than pre-operation during the half year follow up period in TIPS plus PSE and surgery group. There was no significant difference among the two groups in mortality, variceal rehemorrhage, survival rates. Two patients in EGDS group were developed portal vein thrombosis (PVT). TIPS plus PSE group showed a better outcome in the incidence of postoperative encephalopathy. (3) The survival of the patients whose MELD score under 15 were showed significantly higher than the patients above MELD score 15. The area of ROC that predict survival was 0.866 and 0.863 at 3 months,0.755 and 0.739 at 1-year,0.729 and 0.750 at 2-years respectively for the MELD score and the CTP.Conclusions(1) TIPS is a safe and effect method of intervention surgical method, which can reduce portal hypertension significantly. And it could prevention the variceal bleeding. TIPS has influence on liver function, but has no relative complications; the renal function has been improved. (2) TIPS combines with PSE could treat portal hypertension variceal bleeding and hypersplenism. Compared with EGDS, the combined method have an advantage of little trauma, the incidence of portal vein thrombosis and hepatic encephalopathy are lower than the surgical team. And the new embolization material can reduce the incidence of complication after operation. So, combines with the two methods will gain well clinical application value. (3) Both MELD score and CPT could predict short-term survival accuracy, but poor in long-term. More work should need to improve the accuracy of the model.