Transjugular Intrahepatic Portosystemic Shunt Treatment Of Portal Hypertension In Clinical Study

Objiect:To Observe the main Fluency covered stent with transjugular intrahepatic portosystemic shunt(TIPS) and its relationship with variceal vein embolization, partial splenic embolization combined with the clinical therapeutic effect and effect of factors in relation to TIPS.Materials and Methods:Portal hypertension in liver cirrhosis in patients with esophageal variceal bleeding and refractory ascites established the shunt with a transjugular intrahepatic portosystemic shunt,measured the value of portal pressure, portosystemic pressure gradient before and after TIPS placement,Before and after comparison of hematology and serum biochemical in hematology changes,clinical efficacy and complications after TIPS placemen were followed-up.Results:50 patients(male/female 37/13) with liver cirrhosis and portal hypertension were performed with a TIPS,aged 15 to 79 years old,the average 51.04±14.34 years old;liver function classification:Child-Pugh A 10 cases,Child-Pugh B 28 cases, Child-Pugh C 12 cases.TIPS placements were performed successfully,its success rate was 96%(48/50).48 cases patients were followed-up at 3-24 months(the average of 15.8 months),46 cases survival,2 cases dead;Portal venous pressure from before TIPS 37.47±7.49 cm H2O to after TIPS 26.20±5.83cm H2O,(P＜0.05),there is a statistical significant,nine cases occurred rebleeding after TIPS and the rebleeding in relation to shunt stenosis and obstruction.During following up the incidence of stent restenosis was 14.6%within one year,the incidence was 18.8%within two years; eight cases occurred hepatic encephalopathy after TIPS,the incidence of hepatic encephalopathy was 16.7%;4 cases refractory ascites reduce or disappear after TIPS and it's efficient was 80%,1 case refractory ascites slowly dissipated.Conclusion:TIPS with stent is an effective way on the treatment of portal hypertension in liver cirrhosis with upper gastrointestinal hemorrhage.TIPS can reduce portal pressure,and partly improve renal function,in control of refractory ascites have the double clinical significance.TIPS of portal pressure control to reduce the range of 20-40%in appropriate,and can reduce the occurrence of hepatic encephalopathy;TIPS comined variceal vein embolization can reduce the incidence of gastrointestinal hemorrhage,the prevention of restenosis and portal thrombosis is also useful.TIPS may increase the damage of liver function,Alanine aminotransferase, aspartate aminotransferase and serum albumin to monitor liver function of injury after TIPS has important clinical significance;HP infection and serum urea nitrogen abnormal increase were hepatic encephalopathy occurred in high-risk factors,serum urea nitrogen abnormally high has higher than HP infection in risk of hepatic encephalopathy,controling HP infection and improvement in renal function can reduce the incidence of hepatic encephalopathy;Child-Pugh classification is a protective factors of stent restenosis,Child-pugh classification is higher for the protection role of stent patency;liver function in patients with Child-Pugh classification A and the younger used cautiously with TIPS;Double stent(covered stent+bare stent) could enhance the vertical support force on the stent,and it has very important significance for protecting liver function and preventing stent restenosis,but it will increase the treatment of economic costs;TIPS combined a variety of treatment can improve the curative effect.