| ObsjectiveEsophagogastric variceal bleeding is the most common complications and death in patients with cirrhosis. This paper TIPS were retrospectively analyzed in combination with GCVE treatment of cirrhosis esophageal gastric varices and the curative effect of upper gastrointestinal bleeding(the bleeding rate, portal vein pressure changes and rebleeding rate),compared with TIPS preoperative and postoperative biochemical index (ALTã€ASTã€TBILã€IBILã€PTã€INRã€PLT) and portal vein pressure changes, follow-up and analysis on postoperative complications (stent stenosis and obstruction, the incidence of hepatic encephalopathy),using treatment of TIPS combined GCVE and provide theoretical basis for variceal bleeding with liver cirrhosis.MethodsCollected between January 2009 and June 2014,80 cases of liver cirrhosis patients with esophageal gastric varices bleeding who underwent TIPS combined with GCVE.53males,27 females,aged 28-76years old(53±10years). Classification of liver function for Child-Pugh,respectively 10 cases of class A,class B 39 cases and class C 31 cases.15 cases who underwent endoscopic treatment(ligation or injection of hardener)before TIPS.1 cases who underwent surgical splenectomy.Observed the curative effect of TIPS+GCVE(the hemostatic rate,portal vein pressure changes,and rebleeding rate)and the change of blood routine,liver function, blood coagulation function.And in postoperative 1 week 6 months and 12 months abdominal vascular ultrasound, portal vein CTA and MRA or portal vein angiography revealed directly support function,On the postoperative complications (stent stenosis,obstruction,the incidence of hepatic encephalopathy) and survival status follow-up and analysis.Follow-up until January 31,2015.Application SPSS17.0 statistical software package, the related indexes were analyzed.Results1.Surgical success rate was 100%,and 80 patients in the 6 to 24 months follow-up period(13 months),59 cases (73.8%),21 cases died (26.2%);Causes of death including gastrointestinal rebleeding (10 cases,47.6%), hepatic encephalopathy (4 cases,19%), liver failure (5 cases,23.8%), concurrent liver cancer (2 cases,9.6%).2. Portal vein pressure from shunt before 27.8715.76 mmHg lower to 18.18 ± 5.54mmHg after shunt(P< 0.01).3.EGVB control is 98%; rebleeding rate of 1 month,6 months,12 months were 3%,11.5% and 13% respectively postoperative stent dysfunction of 6 months and 12 months were 15.4% and 26.2% respectively.4. Postoperative 1 week liver meritorious service is changed,6 months and 12 months compared with preoperative liver meritorious service is no statistical difference (P> 0.05);Platelet preoperative and postoperative 1 week, the statistical difference (P< 0.05), but compared with the postoperative 6 months and 12 months without statistical significance (P>0.05);5.The incidence of postoperative hepatic encephalopathy (HE) is 18.8%, the higher the Child-Pugh classification,HE is easier to induce (P<0.05). Comclusion:1.Esophageal hemorrhage of upper gastrointestinal tract resulted from gastric varices is one of the most common complications and death in patients with cirrhosis.TIPS combined with GCVE surgical success rate is high,a significant reduction in the portal vein pressure,the recent hemostatic effect is good, the occurrence of postoperative liver function decline and shunt way has a certain relationship, stent stenosis is one of the important factors affect the long-term curative effect, were positively correlated with the incidence of rebleeding;2.Clinical analysis show that on prognosis of patients with TIPS to postoperative bleeding, the Child classification and preoperative bilirubin level.TIPS for 24.5% incidence of postoperative long-term bleeding again, including bleeding again a mortality rate of 47.6%;The higher the Child classification, risk of death;Preoperative bilirubin level is higher, the prognosis is poor.3.The incidence of postoperative hepatic encephalopathy (HE) was 18.8%, and be paid attention to the prevention and treatment;... |
