ABSTRACT
Objective To analyze the prognostic factors in treating variceal hemorrhage patients of liver cirrhosis and portal hypertension with transjugular intrahepatic portosystemic shunt (TIPS).Methods From January 2003 to December 2008, the data of 162 variceal hemorrhage patients with liver cirrhosis and portal hypertension treated with TIPS was collected, which included basic information, biochemical examination results within 7 days before the operation, regular follow-up observation after the surgery and survival data. The survival prognostic indexes were assessed with Cox regression model. Results The successful rate of TIPS was 99% (161/162). The median follow up duration was 21 months. Child-Pugh score and blood platelet count (PLT) were closely correlated with survival (P = 0. 003 and 0. 024). The total cumulative survival rate in patients with Child-Pugh score below nine (75%, 102/136) was higher than over nine (50%, 13/26) (χ2 = 9. 12,P=0. 003).The total cumulative survival rate of patients with PLT count over 47 ×109/L (74%, 82/112) was higher than below 47 × 109/L(66 %, 33/50, χ2 =4. 528, P = 0. 033). The one year after operation cumulative survival rate of liver function Child-Pugh class A, B, and C was 92%, 85%, 55% respectively. Conclusion Child-Pugh score and platelet count are independent predictable factors for the survival of variceal hemorrhage patients with liver cirrhosis and portal hypertension treated by TIPS. The risk increase after operation when Child-Pugh score over 9 and/or PLT count less 47×109 /L.
ABSTRACT
Objective To evaluate the safety and efficacy of percutaneous transluminal angioplasty (PTA) in treating Budd-Chiari syndrome (BCS) and to analyze the long-term follow-up results. Methods From October 1998 to May 2008,98 BCS patients (inferior vena cava obstruction,n = 34 ; hepatic vein obstruction, n = 22; combined obstruction, n = 42) who accepted PTA treatment successfully were investigated. The changes of clinical manifestations and liver function post-operation were observed; the long term survival rate was evaluated. Results Only two patients were complicated with transhepatic puncture tract bleeding, the prognosis was good after emergency operation. Sixty patients presented with low extremities edema, which was fully subsided after PTA.Of eighty-eight ascites patients, ascites disappeared in eighty patients after operation, and in the other eight patients combined with oral diuretic treatment post-operation. The median Rotterdam prognostic score of one month post-operation and the last follow-up time point was 0. 11 and 0. 09, significantly lowered than pre-operation (1.12). The difference was statistical significance (P=0. 000). At 1, 3, 5 years postoperative, the cumulative vessel patency rates were 96%, 94% and 94% respectively, and the cumulative survival rates were 94%, 91% and 87%. Conclusions Treating BCS with PTA has a high success rate, a good safety and a long-term survival rate.
ABSTRACT
Objective To evaluate the effect of hepatic vein occlusion and stent replacement in treatment for Budd-Chiari syndrome(BCS).Methods Forty three patients with BCS were underwent percutanous puncture,radiography,transjugular angioplasty,balloon dilation and stent placement for hepatic vein under Doppller ultrasounographic guidance from July 2001 to September 2006. Results Technical success was 100%with no complications.The medium vein pressure was reduced from 32.5 tO 20 cm H2O(1 cm H2O-0.098 kPa)after stents replacement(P＜0.01).The hepatic vein angioplasty revealed that all stents were patent and branches were disappeared.The symptoms in 38 patients were disappeared immediately,and improved in 5 patients.All patients were followed up of 32 months(ranged 1-62).Except one patient died of severe gastric bleeding,the 42 patients were survived with symptoms free.Conclusion Hepatic vein occlusion and stent replacement are safe and effective in treatment of BCS.