A Clinical Study On Transjugular Intrahepatic Portosystemic Shunt For Portal Hypertension

Objective: The purpose of this study was to analyse the clinical effect and complications for transjugular intrahepatic portosystemic shunt (TIPS) in treating the patients of cirrhosis with portal hypertension.Methods: A retrospective analysis method was used on the 280 patients with portal hypertension,all of them underwent TIPS in the department of gastroenterology ,General Hospital of chengdu Military Command,from January 2000 to January 2009 .The 256 cases were strictly followed up for 1 year(24 cases were lost),We analysed their data with SPSS13.0 statistical package.Results: TIPS was successfully performed in 278 patients (the success rate was 99.3%). The portal pressure dropped from 46.5±3.4 cmH2O to 26.8±3.6cmH2O,the internal diameter of portal changed from 1.68±0.15cm to 1.32±0.11cm , portosystemic pressure gradient(PSG) dropped from 33.65±5.47cmH2O to 13.63±2.46cmH2O (P < 0.01).The symptom of varicosity and ascites were alleviated obviously. Liver function decreased almost occured within 3 months after TIPS,and the patients in Child-Turcotte-Pugh class C had the worst result. The incidence of stent stenosis was 18.75%(48/256) and the incidence of hepatic encephalopathy was 8.20% (21 /256) within 1 year.Conclusion: TIPS creation is an effective method to control esophagogastric variceal bleeding(EGVB) caused by portal hypertension,which is inaccessible to endoscopic and pharmacological therapy ,especially in acute bleeding , TIPS can reduce portal hypertension immediately,and is also helpful to the ascites retreat. Patients underwent TIPS may have liver fanction decrease in some degrees within a short time. We choose direct transcaval approach and postoperative use of anticoagulant drug to prevent shunt stenosis. The incidence of Hepatic encephalopathy is associated with the liver function before treatment,puncture the left or right branch of portal vein,and the diameter of stent .