ABSTRACT
Objective:To investigate the current situation of the use of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension, which should aid the development of TIPS in China.Methods:The China Portal Hypertension Alliance (CHESS) initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research. The survey included the following: the number of surgical cases, main indications, the development of Early-TIPS, TIPS for portal vein cavernous transformation, collateral circulation embolization, intraoperative portal pressure gradient measurement, commonly used stent types, conventional anticoagulation and time, postoperative follow-up, obstacles, and the application of domestic instruments.Results:According to the survey, a total of 13 527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021, and 94.1% of the hospital had the habit of routine follow-up after TIPS. Most hospitals believed that the main indications of TIPS were the control of acute bleeding (42.6%) and the prevention of rebleeding (40.7%). 48.1% of the teams carried out early or priority TIPS, 53.0% of the teams carried out TIPS for the cavernous transformation of the portal vein, and 81.0% chose routine embolization of collateral circulation during operation. Most of them used coils and biological glue as embolic materials, and 78.5% of the team routinely performed intraoperative portal pressure gradient measurements. In selecting TIPS stents, 57.1% of the hospitals woulel choose Viator-specific stents, 57.2% woulel choose conventional anticoagulation after TIPS, and the duration of anticoagulation was between 3-6 months (55.4%). The limitation of TIPS surgery was mainly due to cost (72.3%) and insufficient understanding of doctors in related departments (77.4%). Most teams accepted the domestic instruments used in TIPS (92.7%).Conclusions:This survey shows that TIPS treatment is an essential part of treating portal hypertension in China. The total number of TIPS cases is far from that of patients with portal hypertension. In the future, it is still necessary to popularize TIPS technology and further standardize surgical indications, routine operations, and instrument application.
ABSTRACT
Objective:To study the use of three-dimensional reconstruction in preoperative evaluation of complicated hepatic echinococcosis in Tibet.Methods:Sixty patients with complex hepatic hydatidosis admitted to the People's Hospital of Tibet Autonomous Region from April 2020 to August 2020 and planned to undergo radical hepatectomy were enrolled in this prospective randomized controlled study. The patients were randomly divided into the preoperative CT group and preoperative 3D reconstruction group by computer generated random numbers, with 30 patients in each group. Those with odd random numbers were enrolled in the preoperative CT group, and those with even random numbers were enrolled in the preoperative 3D reconstruction group. According to the imaging results, the operation plan was developed, and the coincidence rates of the preoperation plan with intraoperative decision, and postoperative complications were compared between the two groups.Results:There were 27 males and 33 females, aged (40.7±12.7) years. In the preoperative CT group, 53.3% (16/30) of the operation carried out were consistent with the preoperative planned operations. The corresponding figure for the preoperative 3D reconstruction group was 86.7% (26/30). The difference between the two groups was significant ( P<0.05). In the preoperative CT group, the operative time was (220.0±32.3) min, the intraoperative blood loss was (523.0±47.1) ml, the number of patients requiring hepatic blood inflow occlusion was 25 (83.3%), and the time of hepatic blood inflow occlusion was (32.1±5.8) min. In the preoperative 3D reconstruction group, the operative time was (156.0±17.6) min, the intraoperative blood loss was (212.0±21.5) ml, the number of patients requiring of hepatic blood inflow occlusion was 15 (50.0%), and the time of hepatic blood inflow occlusion was (16.2±3.4) min. The differences between the two groups were also significant (all P<0.05). Conclusion:Preoperative three-dimensional reconstruction of complex hepatic echinococcosis in Tibet effectively improved the safety of surgery.