The Clinical Study Of TIPS With GCVE In Treating Portal Hypertension With Upper Gastrointestinal Bleeding

ObjectiveTo compare the clinical curative effect between transjugular intrahepatic portosystemic stent-shunt (TIPS) and gastric coronary vein embolization (GCVE).Include the diversity of Portal venous and spleen blood flow dynamics,spleen morphology,liver function,blood routine test,degree of gastrointestinal varicose veins,EHR,RR,HER,PRR and RPR. And analyze the necessity,feasibility and clinical curative effect of TIPS+GCVE.MethodsThirty-eight patients were randomly divided into2groups,group A and group B. PVB,PVP,PVV,SVCI,SMA and ST were measured by DU in Preop, Postop7day,1,3,6and12months. The change of gastrointestinal varicose veins were inspected by gastroscope. ALT,AST,ALB,TBIL and PLT were tested in Preop,Postop12-48h,1,3,6and12months. EHR,RR,HER, PRR,RPR and change of Liver function serological were followed,and the relationship between stents remote location and HER was analyzed.ResultsPVB decreased,PVV accelerated,PVP and SVCI reduced in both group(P<0.05),group B was more obvious than group A. Inter-group comparation between Preop and Postop, among-group comparation in the same Postop period, ALT,AST,ALB,TBIL,PLT were no significant difference, and the same results from the angle of Child-Pugh liver function classification. The IR of esophageal varices was66.6%vs.94.7%(group A vs. group B)(P<0.05),EHR was75.0%vs.100.0(group A vs. group B)(P<0.05), IR and EHR were both significantly improved in each group, and group B was better than group A(P<0.05).RR group A vs. group B(4.3%vs.28.5%), group B was lower than group A (P<0.05). HER group A vs. group B (21.4%vs.21.7%),PPR (92.8%vs.86.9%)and RPR (100%vs.100%), among-group comparation was no significant difference (P>0.05).When the distal end of coated stents was located in the left branch of portal vein, HER was significantly lower than the group of right (P<0.05)Conclusion1. TIPS can really reduce PVP, it is the effective method to treat UGH the PHT's serious complication. The application of coated stents obviously improve the shunt way patency rate.2. TIPS+GCVE group's Postop IR of esophageal varices and styptic effect in the patients with PHT and UGH was significantly better than TIPS group.3.TIPS (whether simultaneously give GCVE) has no significant effect on RR, HER,PRR,RPR.4. TIPS can significantly reduce PVP,PVB and increase the PVV. And there's no significant effection whether simultaneously give GCVE.5. In the use of8-10mm coated stents, choose left branch portal for TIPS, can obviously reduce the HER.6. TIPS simultaneously give GCVE do not significantly increased Postop complications.7. Although TIPS can obviously reduce the SVCI,but SMA,ST and PLThas no significant change in patients with PHT and hypersplenism; 8. It is deserved a further study on "Whether TIPS with PSE could obviously improve the liver function?".