The Clinical Study Of Refractory Ascites Due To Liver Cirrhosis Treated With Modified TIPS Combined With Chinese Traditional Medicine

1.ObjectivesTo observe the clinical efficacy of refractory ascites due to liver cirrhosis treated with modified transjugular intrahepatic portosystemic shunt combined with Chinese traditional medicine.2.Methods2.1 CasesAll cases are hospitalized patients in Ditan Hospital,from June,2004 to June,2008;aged from 35-76.All patients meet the diagnosis of refractory ascites due to liver cirrhosis.2.2 Therapeutic regimenAll 64 cases were divided into 3 groups according to the admission time,one for contrast group(from June,2004 to January,2006);one for the therapeutic groupⅠ(from January,2006 to June,2008);the other one for the therapeutic groupⅡhospitalized in the same period with groupⅠ.Take the contrast group and the therapeutic groupⅠas contrast study befor and after TIPS,to assess the safty and feasibility of the modified TIPS.Take the therapeutic groupⅠand the therapeutic groupⅡas randomized contemporary controlled study,to assess the clinical efficacy of refractory ascites treated with modified TIPS combined with Chinese traditional medicine.The stent type:8MM×60MM,made in US Bard Co.2.3 Proccedures2.3.1 The contrast group:The patient lays supine,take the right internal jugular vein as the puncture vessel,puncture it under the guidance of Ultrasound with 22G needle,put the guide wire into the inferior vena cava,the Rups-100 is advanced into the right hepatic vein,and puncture the right portal vein,if blood can be freely aspirated,contrast agent is injected to confirm that the catheter has entered a portal vein,An 8mm angioplasty balloon is inflated across the parenchymal track.The sites of balloon waist formation are good indications of the potal and hepatic vein ends of the track.a stent is deployed around a curve under the guidance of fluoroscopy.2.3.2 The therapeutic groupⅠ:Take the right auxiliary 8^thribs space as the puncture site,puncture the right portal vein under the guidance of Ultrasound,after a successful puncture,put the guide wire into the portal vein,then the theath with gold marker is advanced into the portal vein,put the gold marker in the puncture site in the portal vein and puncture the marker with Rups-100 under fluoroscopy.After a successful puncture,dilated the tunnel with balloon inflation and deployed the stent according to the balloon waist across the parenchymal track.2.3.3 The therapeutic groupⅡ:The modified TIPS procedure is same to that of the therapeutic groupⅠ.After the modified TIPS,patients take the Chinese traditional medicine for 30 days from the first day after modified TIPS.2.4 Observations2.4.1 The effectiveness of refractory ascites relieved.2.4.2 The changes of hepatic and renal function,and ammonia level.2.4.3 The complications of the treatment.3.ResultsGood effectiveness have been achieved in the contrast group and the therapeutic groupⅠ,however,better effectiveness have been acquired in the therapeutic groupⅡ(the modified TIPS combined with Chinese traditional medicine),the statistics s-how that the difference to compare the latter group with the former two groups is significantly(P＜0.05).And the safiy and feasibility of the procedure has been greatly improved in the modified TIPS group.The observations also show that there are no significant changes of hepatic and renal function before and after TIPS.Whether the modified TIPS combined Chinese traditional medicine treatment can improve the survival rate or not will need further observations and study.4.ConclusionsThe modified TIPS combined with Chinese traditional medicine therapy is safe and effective in the treatment of refractory ascites due to liver cirrhosis.The outcome of portal pressure declined after TIPS has resulted in the change of haemodynamics.The change of haemodynamics and the effect of the Chinese traditional medicine play an important role in curbing the development of refractory ascites.To modified TIPS procedure with the help of ultrasonic guidance and marker localization can also greatly improve the safty and feasibility of TIPS procedures.