TIPS Treatment Of Hepatic Sclerosis Portal Hypertension In Therapeutic Effect Evaluation

[objective] To observe bleeding again,Hepatic encephalopathy,stent stenosis, ascites absorption, life cycle, Hepatic function tests main index change.blood test main index change and curative effect evaluation after Transjugular Intrahepatic Portosystenic Stent Shunt(TIPS).[methods] to use TIPS cure bleeding from esophageal varices and refractory ascites because of Cirrhosis and portal hypertension, follow-up visit Hepatic function tests main index change, blood test main index change after postoperation one month, three month, six month, twelve month, and record postoperation bleeding again. Hepatic encephalopathy, Stents narrow time, ascites absorption.and observe Hepatic function tests main index change, blood test main index change After the balloon expanded again before for stent stenosis patients.[results]TIPS cure Patients with cirrhosis portal hypertension 82 case(male/female 58/24),age from 15 to 81 years old. mean age 51.87 dr 14.13 years old, liver function grade Child-PughA 14 case, Child-PughB 43 case, Child-PughC 25 case. TIPS success rate Is 100%,73 cases in follow-up periods from 3-24 months (mean 12.25 month),66 case survival.16 case death, statistic analysis Hepatic function tests main index, there's no No statistically significant differences compared Hepatic function tests main index change after TIPS one week, two to four week, three month, six month and one year with preoperation's. statistic analysis urea nitrogen and creatinine compared Concurrent ascites with no ascites patients, on the renal function of patients with ascites six group take a turn for the better, on the renal function of patients with no ascites six group take a turn for the better too, but curative effect unstabitily. statistic analysis red blood cell and platelet pre and post tipps, there is no curative effect with hypersplenism patients, to follow-up visit eighty case with covered stent patients, three month binary stenosis is 1.3%,six month binary stenosis is 13.9%,twelve month binary stenosis is 30%. decreased binary stenosis compared with bare stents, to follow-up visit fifteen patients with double bracket for one year, there is no stent stenosis occour, to follow-up bleed again after tipps, short term Hemostatic rate is 100%. One year rebleeding rate and two year rebleeding rate respectively 17.6%,20%, Hemostatic effect is good.71.4% patients for bleed again because of stent stenosis and recurrence of varicosities, there is no statistically significant differences to HE Incidence compared with patients to use bracket with 8mm and 10mm diameter, moreover, HE occur in short time. HE Incidence stabilize as time goes on. to analyse Survival Time of sixteen patients who had died, median survival time is twelve month.[conclusion] there was 13.7%,17.6%and 20%in six, twelve, twenty four month TIPS postoperative bleed again. The major reason for postoperative bleed again was stenosis and seclusion. TIPS is an effective method to cure Cirrhosis and portal hypertension with upper gastrointestinal hemorrhage,more, rebleeding rate decreased at a specified future date, take precautions against Severe vomiting after tipps may guard against upper gastrointestinal hemorrhage because of Weiss syndrome, in a short time liver function may damage after TIPS because of mechanical damage and portal shunt. But from medium and long-term, TIPS have little influence in liver function, pute TIPS have little influence in hemogram change. Hypersplenism have little influence in hemogram change too. TIPS decreased portal hypertension, also partly impoved renal function, and was benefit of ascites absorbing. Using covered stent may significantly reduced stents stricture rate. Using double bracket(covered stent and bare stents) largely decreased stents stricture rate too. but it will increased cost of treatment. TIPS choose moderate Stents diameter, choose moderate Shunt way radian, Shunt way establish in Hepatic vein in the left branch of the portal may decrease HE occur. HE mainly occur in the short term after TIPS, HE incidence come to be stable as time goes on. hepatic encephalopathy is the main reason for TIPS death, the worse liver function, the more death rate.