Clinical Study Of Transjugular Intrahepaticpor-tosytemic Stent Shunt With Covered Stent

Background:Transjugular intrahepatic portosystemic shunt (TIPS) has been widely applied inportal hypertension complications, especially esophageal and gastric varicealbleeding and refractory ascites. A large number of randomized controlled trials andMeta analysis, the rate of recurrence variceal bleeding could successfully be reducedand symptoms refractory ascites could be effectively relieved by TIPS insertion.Theposition of TIPS could be affected because of stent stenosis,HE incidence and failedto demonstrate a survival benefit. TIPS has not been recommended by AmericanAssociation for the Study Liver Disease (AASLD) as primary therapy for portalhypertension.With the extensive application of the covered stent, the above problemscan be perfected.Objective:To explore the curative effects，the incidence of complications of covered stentin transjugular intrahepatic portosystemic shunt (TIPS) in treatment of the patientswith portal hypertension.Methods:In-patient data were collected from56patients between February2012andFebruary2014who suffured from portal hypertension. Among them26patientsreceived TIPS with Covered Stents (TIPS group) while30patients receivedendoscopic therapy (ET group). Portal vein pressure changes,liver function werecompared before and after operation.The56cases were followed for3mo to24moths. To evaluate the clinical effect, the recurrent bleeding rate, Stent patency rate,incidence of hepatic encephalopathy,mortality and hospitalization times, fees wererecorded and analyzed.Results:There was no significant difference in gender, age,clinical manifestations,liverfunction and laboratory indicators between the two groups.TIPS creation was successfully accomplished in all26patients, Twenty-six covered stents were successfully implanted.All covered stents were8mm, Meanpottal venous pressure decreased from preoperation (39.8±6.7cmH2O) topostoperation (21.9±6.5cmH2O)（P<0.05）.No significant differences at the level of albumin,total bilirubin and beforeand after operation (P>0.05).Significant differences at the level of Child-Pugh scoreand prothrombin before and after operation (P＜0.05).K-M survival analysis shown that the cumulative shunt patency rates at3,6,12and24months were86.7%，80%，72.7%，72.7%;.The cumulative free of variceal rebleeding rates at3,6,12and24months inTIPSgroup and ET group were92.3%，83.9%，75.6%，66.1%and88.2%，76.5%，63.1%，63.1%.The cumulative free of hepatic encephalopathy rates at3,6,12and24monthsin TIPS group and ET group were:84.6%，76.9%，69.2%，69.2%and85.1%，85.1%，76.6%，76.6%，respectively.There was no significant difference between the twogroups (p=0.72>0.05).There was no significant difference between the two groups with respect tosurvival rates (Kaplan-Meier analysis and log-rank testχ2,, P=0.34).The average total cost for the TIPS group was higher than for ET group（P＜0.05）;but hospitalization frequency and hospital stay during follow-up period werelower(P＜0.05).Conclusions:TIPS with covered stent was effective in treatment for patients with portalhypertension.It could be effectively control variceal rebleeding, relieve symptoms ofrefractory ascites.TIPS with covered stent could not increase liver dysfunction and the incidenceof hepatic encephalopathy...