| Objective: To explore the clinical effect of transjugular intrahepatic portosystemic shunt(TIPS) and percutaneous transhepatic variceal embolization(PTVE) on the treatment of cirrhosis with esophageal gastric varices bleeding.Method: 1. The data of 61 patients of liver cirrhosis combined with esophageal gastric varices bleeding in the third central hospital of tianjin and tianjin first central hospital who underwent the interventional treatment from January 2011 to January 2014 were included in the retrospective analysis, including 40 men and 21 women, the average age were 56.75±11.72 years old. The preoperative liver function were Child-Pugh A or B. Patients were divided into two groups, PTVE treatment group(n=42), and TIPS treatment group(n=19). The success rate of clinical treatment, the rebleeding rate, the alleviation of varicose veins, the incidence of hepatic encephalopathy, survival rate and liver function parameters were compared between two groups. Compared the change of portal vein pressure before and after TIPS, observed stent stenosis rate.2. Statistical method: We used SPSS19.0 statistical software for analysis, we used( x ±s) to denote measurement data, and used cases(n) and % to denote count data. We used paired t test to compare the change of portal vein pressure before and after TIPS. Using analysis of variance and LSD- t test to compare liver function parameters of two groups. Using Kaplan-Meier analysis and Log-rank test to compare the rebleeding rate, hepatic encephalopathy rate, survival rate. The comparison of the situation of varicose veins alleviated and stent stenosis rate used ?2 test. P < 0.05 was statistically significant.Results: Two groups of surgery were successful, operation success rate was 100% and the portal vein pressure decreased obviously in TIPS group, the difference was statistically significant(t=8.397,P=0.000). The rebleeding rate was higher in PTVE group(78.6%) than that in TIPS group(63.2%), the difference was statistically significant(?2=4.815,P=0.028). The total alleviation rate of esophageal gastric varices was significantly lower in PTVE group(50.0%) than that in TIPS group(89.5%), the difference was statistically significant(?2=7.079, P=0.008). The incidence rates of hepatic encephalopathy were 9.5% and 21.1% for PTVE group and TIPS group respectively, there was no statistically significant difference between two groups(?2=2.252, P=0.133). The two-year cumulative survival rates of PTVE group and TIPS group were 95.2% and 89.5% respectively, and there was no statistically significant difference between two groups(?2=0.468, P=0.494). After surgery, the liver function parameters were not significantly different from those determined before the treatment in PTVE group. At 1, 3 months after the TIPS, the liver functions declined obviously. At 6, 12 months after the treatment, the liver functions of TIPS group were not significantly different from those determined before the treatment. The stent stenosis rate of bare stent combined coverd stent was 16.7%, which was lower than bare stent, the difference was statistically significant(P<0.05).Conclusion: 1. PTVE and TIPS has the same hemostatic effect on liver cirrhosis with varicose vein hemorrhage.2. The transient liver function deterioration is observed in the short period after TIPS, liver function can return to preoperative levels in about six months. Therefore, it is necessary to strengthen the protection with liver after TIPS.3. There is no significant augment in the incidence of postoperative HE, it is related to selection of the appropriate cases and postoperative management and monitoring.4. The surgery of TIPS is safe and ideal interventional treatment for cirrhosis with esophageal gastric varices bleeding, which has the lower rebleeding rate, better esophageal gastric varices alleviation rate and long term less influence in liver function. |
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