| Objective To evaluate the clinical efficacy of transjugular intrahepatic portosystemic shunt(TIPS) combined with stomach and esophageal variceal embolization(SEVE)for gastric variceal haemorrhage, and the efficacy with or without a gastrorenal shunt. And to evaluate the efficacy and safety of TIPS combined with SEVE in patients with gastric varices associated with a gastrorenal shunt(≥5 mm in diameter).Methods(1) A total of 52 patients with gastric variceal bleeding history and portal hypertension treated with TIPS combined with SEVE were included from October 2013 to March 2015. According to the CT angiography before the operation, patients were divided into two groups. Group A:27 cases with gastric variceal haemorrhage associated with a gastrorenal shunt. Group B:25 cases with gastric varices bleeding without gastrorenal shunt. During the follow-up period,the incidence of the total rates of rebleeding, TIPS primary patency, hepatic encephalopathy and survival were compared, and the rates were also compared between the group A and group B.(2)From October 2013 to January 2016, the clinical data of 26 patients with portal hypertension caused gastroesophageal variceal bleeding and treated by TIPS combined with SEVE were collected. The difference of portosystemic pressure gradient between before and after operation was observed, and Child-Pugh score were collected. The hemostasis in 24 hours, TIPS primary patency, rebleeding, hepatic encephalopathy(HE), hepatic failure and mortality were evaluated after operation. The change of liver function and thrombocytopenia were recorded after operation. Student’s t-test or analysis of variance was performed for statistical analysis of measurement data.Results(1) In all patients, the average portal vein pressure decreased from(36.50 ± 7.00) ㎝ H2 O before operation to(28.15 ± 6.27) ㎝ H2 O after TIPS combined with SEVE, and the difference was statistically significant(t=10.357,P=0.001). 52 patients were followed up for 1 to 18 months(Group A:range 1-18 months; Group B:range 1-15 months), the total rates of rebleeding, TIPS primary patency, hepatic encephalopathy and survival were 11.54%(6/52), 86.54%(45/52), 11.51%(6/52) and 92.31%(6/52), respectively. There were no significant differences between the two groups in the total rates of rebleeding [11.11%(3/27)vs.12.00%(3/25), P=1.000], TIPS primary patency [88.89%(24/27)vs.84.00%(21/25), P=1.000], hepatic encephalopathy [14.81%(4/27)vs.8.00%(2/25), P=0.738] and survival [92.59%(25/27)vs.92.00%(23/25), P=1.000] after TIPS combined with SEVE.(2)In the 26 patients, the average portal vein pressure decreased from(36.32±5.45) ㎝H2O before operation to(26.23±5.79) ㎝H2O after TIPS combined with SEVE, and the difference was statistically significant(t=6.254,P﹤0.01). The difference of portal vein pressure before and after operation was(10.09±3.24) ㎝H2O. No hepatic failure was observed in all 26 patients. Among 15 patients with emergency operation,14 patients obtained successful hemostasis in 24 hours. No operation related complications were observed in all the patients. During the follow-up period of 26 patients, the rates of rebleeding,TIPS primary patency,and hepatic encephalopathy(HE) were 15.4%(4/26), 92.3%(24/26),and 19.2%(5/26),respectively. Mortality was 3.8%(1/26). There were no significant differences in Child-Pugh score, blood ammonia level,albumin,bilirubin,white blood cell, and platelets before and after operation(all P>0.05).Conclusion(1)TIPS combined with SEVE is effective for gastric varices, and equally effective in the treatment of both gastric variceal haemorrhage associated with a gastrorenal shunt and gastric varices bleeding without gastrorenal shunt.(2)TIPS combined with SEVE in the treatment of patients with gastroesophageal varices accompanied by a gastrorenal shunt with a diameter over 5 mm could effectively control bleeding, and no ectopic embolism happened. |
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