Effects Of TIPS On Portal Hemodynamics And Liver Reserve Function

BackgroundTIPS has been an effective treatment for complications of portal hypertension.However,there are some complications after TIPS,such as hepatic encephalopathy and shunt dysfunction.Hepatic portal blood flow index can reflect the blood flow of Portal vein and There is no literature reported in TIPS.ICG test is regarded as a valid approach to assess the liver reserve function and its application in TIPS has not been reported in the literature.So the change of ICG and hepatic portal blood flow index and its relationship with post-TIPS complications worth further study and discussion.ObjectiveTo observe the clinical efficacy of treatment for esophagogastric bleeding,refractory ascites and the occurrence of post-TIPS complications such as hepatic encephalopathy,shunt dysfunction.To analyze the change of some clinical indicators(liver function,blood ammonia,portal blood flow index,ICG R15)after TIPS.MethodsA prospective study was conducted in the First Affiliated Hospital of Zhejiang University from November 1st,2015 to December 1st,2016.14 patients with portal hypertension was eligible for TIPS.Blood routine,Liver function,blood ammonia,Portal ECT and ICG test were completed before TIPS.Blood routine,Liver function and blood ammonia were reexamined the next day after TIPS,portal ECT and ICG test were reexamined within three days after TIPS.The pressure of portal vein was measured before and after the insertion of stent.To compare and analyze the change of these clinical indicators.Every patients was followed up for 2 weeks to 12 months after TIPS to observe the post-TIPS complications.Statistical analysis was performed by SPSS 18.0 software and a p value<0.05 was considered statistically significant.ResultsAll patients was successfully performed with TIPS.13 patients with esophagogastric variceal bleeding has no bleeding after TIPS.Ascites significantly decreased in another patient with refractory ascites.Portal pressure decreased from 31.36�3.20mmHg to 22.79�4.2mmHg after TIPS(P<0.01),Portal blood flow index decreased from 42.69�11.84%to 18.69�9.24%(P<0.01),while ALT increased from 18.67�10.42U/L to 86.17�80.46U/L(P<0.05),AST increased from 24.08+�9.27U/L to 86.67�71.43U/L(P<0.05),TBIL increased from 19.50�10.28umol/L to 41.93�34.23 umol/L(P<0.05),blood ammonia increased from 36.93�14.81umol/L to 84.36�56.35 umol/L(P<0.05).ICGR15 increased from 17.5�8.7%to 27.2�7.6%(P<0.05).There was no significant difference in CHE,ALB,WBC,Hb and PLT before and after TIPS.During the time of follow-up,one patient exhibited an episode of hepatic encephalopathy after two weeks and one patient had esophagogastric variceal bleeding again caused by shunt dysfunction after six months.ConclusionThe applications of TIPS can decrease portal vein pressure and has a significant clinical effect of treatment for esophagogastric bleeding and refractory ascites.But it will damage the liver function and reserve function,decreasing the portal blood flowindex,which may cause some complications such as hepatic encephalopathy,shunt dysfunction.