| Objective:To explore the acute hemostasis,surgical safety,long-term efficacy,complications,and survival of cirrhosis patients with acute gastrointestinal bleeding treated with early-TIPS.Methods:A retrospective analysis was used to collect 80 cases of patients with cirrhosis and gastrointestinal bleeding that were successfully treated by TIPS in the interventional department of the Radiology Department of the Second Affiliated Hospital of Kunming Medical University from January 2010 to December 2017,according to the inclusion criteria.The exclusion criteria were divided into early TIPS group(40 cases)and conventional TIPS group(40 cases).The preoperative and postoperative liver function indexes,the incidence of rebleeding,the incidence of hepatic encephalopathy,and survival were recorded in detail.Follow-up time It is 1 week,2-4 weeks,3 months,6 months,1 year,2 years,3 years,5 years.In case of loss of follow-up,the previous follow-up time was the deadline.In the early TIPS group,inclusion criteria were as follows:1 Patients with cirrhosis and acute gastrointestinal bleeding;2 Patients undergoing TIPS within 5 days after acute variceal hemorrhage.Result:A total of 80 patients were successfully placed in the shunt stent.The success rate of the operation was 100%,and the rate of acute bleeding was 0%.1.40 patients in the early TIPS group,19 males and 11 females,aged 30-86 years,median age 51.5 years.Child-Pugh liver function grade:Grade A in 2 cases,Grade B in 30 cases,and Grade C in 8 cases.In the early group,the portal pressure decreased from 31.05±6.74 mmHg before operation to 20.10±5.72 mmHg,which was significantly different(P<0.01).Seven patients died,16 patients rebleeded,and 14 patients developed hepatic encephalopathy.2.40 patients in the conventional TIPS group,28 males and 12 females,aged 25-74 years,median age 46.5 years.Child-Pugh liver function grade:8 cases of A grade,28 cases of B grade,4 cases of C grade.In the conventional group,the portal pressure decreased from 26.19±6.14 mmHg to 17.48±4.33 mmHg preoperatively,with statistical significance(P<0.01).Six patients died,14 rebleeded,and 11 patients developed hepatic encephalopathy.3.A total of 7 patients in the early group died,accounting for 17.50%of all patients in the early group,of which 4 patients died of hepatic failure and accounted for 57.14%of the early group deaths,which was the main cause of death in the early group;Hemorrhagic death accounted for 28.57%;1 patient died of hepatic encephalopathy,accounting for 14.29%.A total of 6 patients in the routine group died,accounting for 15.00%of the total number in the conventional group.Two patients died of rebleeding and accounted for 33.33%of the deaths in the conventional group.This was the main cause of death in the conventional group;one case was due to hepatic encephalopathy.Death accounted for 16.67%;the remaining 3 cases each died of malignant arrhythmia,pulmonary embolism,and acute respiratory distress syndrome,each accounting for 16.67%.4.The incidence of rebleeding within 1 month,3 months,6 months,12 months,24 months,36 months,and 60 months in the early group was 0%,10.53,respectively.%,14.29%,14.29%,11.11%,0.00%;patients in the routine group within 1 month,3 months,6 months,12 months,24 months,36 months,60 months The incidence of internal rebleeding was 2.56%,0.00%,7.89%,11.43%,11.11%,12.50%,and 11.11%.No statistical difference.5.The incidence of hepatic encephalopathy at 1 month,3 months,6 months,12 months,24 months,36 months,and 60 months in the early TIPS group was 15.00%,30.77%,and 34.21%,respectively.34.29%,39.29%,44.44%,57.14%;incidence of hepatic encephalopathy at 1 month,3 months,6 months,12 months,24 months,36 months,and 60 months in patients with conventional TIPS It is 17.50%,20.51%,23.68%,31.43%,40.74%,43.75%,55.56%.No statistical difference.6.Statistical analysis of preoperative and postoperative liver function indices in 80 patients in both groups.The results showed that liver function decreased in both groups at 1 week postoperatively,2-4 weeks,3 months,6 months,1 year There were no statistically significant differences in changes in liver function at 2 years,3 years,and 5 years.There was no statistical difference in preoperative and postoperative liver function indexes between the early group and the conventional group.7.Statistical analysis of 80 patients undergoing preoperative and postoperative platelet changes in both groups showed that early TIPS did not significantly improve splenomegaly.There was no statistical difference in the index of platelet changes between the early group and the conventional group before and after surgery.Conclusion:1.Early TIPS is a safe and effective treatment that can effectively reduce portal pressure and control acute bleeding.2.Compared with conventional TIPS,early TIPS did not increase the incidence of postoperative rebleeding and hepatic encephalopathy.3.There was no significant difference in the survival rate of early TIPS compared with conventional TIPS and the long-term efficacy was definite.4.It is recommended that TIPS be performed as early as possible in patients with hepatocirrhosis and gastroesophageal variceal bleeding. |
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