The Clinical Study Of Transjugular Intrahepatic Left、right Branch Of Portal Vein Portosystemic Shunt In The Treatment Of Portal Hypertension

To explore the construction of transjugular intrahepaticleft branch of portal vein portosystemic shunt with that of transjugularintrahepatic right branch of portal vein portosystemic shunt and to discusstheir hepatic encephalopathy outcomes in patients with liver cirrhoticportal hypertension.Methods: During the period from March2012to March2014, atotal of37patients with upper gastrointestinal bleeding duo to portalhypertension who were admitted to the hospital were retrospectivelyanalyized. Transjugular intrahepatic portosystemic shunt (TIPS)procedure was carried out in all the37patients. The patients wereallocated into either transjugular intrahepatic left branch of portal veinportosystemic shunt group (n=18) or transjugular intrahepatic rightbranch of portal vein portosystemic shunt group (control group n=19).The ammonia concentration of different branches of portal vein, portalpressure gradient(PPG), technical success rate, the patency of shunt, theammonia concentration of two and seven days after TIPS procedure, theincidence of hepatic encephalopathy six months after TIPS procedure andthe survival rate of two groups were documented and analyzed respectively. Results:Before the treatment, the ammonia concentration ofdifferent tributaries of the portal vein, which corresponding to the samebranch of portal vein, was different in two groups, the difference was notsignificant（P>0.05）. The ammonia concentration of different tributariesof the portal vein is significantly different in two groups. The SuperiorMesenteric Vein(SMV) is higher than the left and right branches of portalvein; And also higher than the Splenic Vein;Right branch of portal veinwas higher than that in the left（P<0.05）; all the difference weresignificant. Technical success rate was100%. After treatment, in bothgroups the PPG became significantly lower than the PPG determinedbefore the treatment（P<0.05）.1day after TIPS procedure, the ammoniaconcentration of elbow venous blood in transjugular intrahepatic leftbranch of portal vein portosystemic shunt group was (78.3+17.6)umol/L,and that in control group was (102.7+41.6)umol/（P=0.024）.7days afterTIPS procedure, that was (57.8+12.4)umol/L、(85.2+38.7)umol/Lrespectively(P=0.007). In transjugular intrahepatic left branch of portalvein portosystemic shunt group, the rang of descending ammoniaconcentration was significant in7days after TIPS procedure than that in1day after TIPS procedure. The same thing was happened in controlgroup, but there was not significant. The difference in survival ratebetween the two groups was no significant. Of the11patients whodeveloped encephalopathy,2were in the transjugular intrahepatic left branch of portal vein portosystemic shunt group and9in the controlgroup. After medication the symptoms of encephalopathy were relieved.The shunt was not obstructed in both groups. Conclusion:The ammoniaconcentration in blood among the different branches of portal vein wasdifference. It indicated that the different shunts may affect the incidenceof hepatic encephalopathy after TIPS procedure. Select left portal vein asTIPS shunt is safe and feasible. Compared with transjugular intrahepaticright portal vein portosystemic shunt, It may narrow down the rang ofammonia concentration and reduce the incidence of hepaticencephalopathy in patients with cirrhotic hypertension. There are certainadvantages. Nevertheless the technical success rate、rate of shunt patency,the incidence of re-bleeding and survival rate of the two groups aresimilar.