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Objective:To explore the medium-long term efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for gastrointestinal hemorrhage in patients with idiopathic non-cirrhotic portal hypertension (INCPH).Methods:From March 2013 to July 2018, clinical data of 13 INCPH patients, including 5 males, 8 females,with gastrointestinal hemorrhage were retrospectively analyzed, who were diagnosed at the First Affiliated Hospital of Zhengzhou University, Anyang Fifth People′ s Hospital and Yuncheng Central Hospital. All patients received TIPS treatment. The general information, postoperative survival rate, the incidence of rebleeding, shunt dysfunction rate, and incidence of hepatic encephalopathy were analyzed.Results:All 13 patients with INCPH completed TIPS successfully with an average age of 45±8 (33 to 59) years. The hepatic venous pressure gradient (HVPG) decreased from 20.0-26.0 (22.6±1.9) mmHg before procedure to 8.0-14.0 (9.4±3.2) mmHg after. The median follow-up time was 44±7 (31 to 53) months. One patient died of liver failure 27 months after TIPS. Hepatic encephalopathy occurred cumulatively in 1 case (1/13), 1 case (1/13) and 1 case (1/13) in 12, 24 and 36 months after TIPS. Stent restenosis occurred cumulatively in 2 cases (2/13), 3 cases (3/13) and 3 cases (3/13) in 12, 24 and 36 months after TIPS. Portal vein thrombosis occurred cumulatively in 2 cases (2/13), and no primary liver cancer developed.Conclusions:TIPS is safe and effective in the treatment of INCPH with gastrointestinal bleeding with favorable medium-long term outcome.
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Objective:To evaluate whether underdilated stent could reduce the occurrence of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation.Methods:A total of 197 patients with decompensated liver cirrhosis, who had underwent TIPS creation at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were analyzed retrospectively, including 110 males and 87 females with age 25-79 (54±11) years old. Uncovered and covered stents with 8 mm diameter were implanted in all subjects, and then dilated by balloon catheters with 6 mm or 8 mm diameter. The patients were divided into two groups, including underdilated group (6 mm, n=105) and control group (8 mm, n=92).Kaplan-Meier curves were used to illustrate cumulative rate of HE, and the differences were assessed with the log-rank test. Multivariate analyses with a Cox regression model were conducted to explore the risk factors for HE. Results:During a median follow-up period of 29 (12-54) months, 16 (15.2%) patients developed HE in the underdilated group and 27 (29.3%) patients in the control group. There was a significant difference in the cumulative rate of HE ( P=0.014), but no statistical differences were found in terms of variceal rebleeding, shunt dysfunction and survival between the two groups ( P=0.608, P=0.659, P=0.968). In multivariated analysis, group assignment (underdilated vs. control, HR=0.291, 95% CI 0.125-0.674, P=0.004) was identified as an independent risk factor for HE after TIPS creation. Conclusion:Underdilated TIPS could reduced the risk of HE compared with completely dilated TIPS, with comparable risk of variceal rebleeding, shunt dysfunction and mortality. And it is worthy of applying this technique to a large sample of patients in clinical practice.
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Objective:To investigate the optimal monochromatic level for evaluation of in-stent lumen after transjugular intrahepatic portosystemic shunt (TIPS) by dual-layer detector CT.Methods:Twenty-nine patients after TIPS were retrospectively enrolled who underwent abdomen enhanced examinations with portal venous phases by a dual-layer detector CT between December 2019 and July 2021. The mixed iterative image (conventional group) and monochromatic images (40 keV group, 50 keV group, 60 keV group and 70 keV group) were obtained by reconstruction. Circular regions of interest were placed in the in-stent of the cross-sectional reconstructed image and in the vertical spinal muscle on the same plane to obtain the corresponding average CT value and noise. The contrast to noise ratio (CNR) and signal to noise ratio (SNR) were calculated. Then 4-point scale was performed to evaluate image quality subjectively by 2 physicians blindly and separately. One-way ANOVA or Kruskal Wallis H rank-sum test was used for the overall analysis between groups, and LSD test or Dunn′s Bonforoni test was used for pairwise comparison within groups. Results:There was no significant difference in noise values among the 5 groups ( P>0.05). The difference of CNR and SNR between the 5 groups was statistically significant ( F=72.28, 56.45, P<0.001). The CNR and SNR in the 40 keV group were the highest, which were 50.4±15.7 and 59.3±18.4 respectively, and the difference was statistically significant ( P<0.001). Subjective scores showed statistically significant differences among the 5 groups (χ2=101.61, P<0.001). The score of the 40 keV group was higher than that of the 60 keV group, 70 keV group, and conventional group ( P<0.001), and there was no significant difference when compared with the subjective score of the 50 keV group ( P>0.05). Conclusions:The 40 keV monochromatic image of dual detector spectral CT is the best image to observe the lumen of the stent after TIPS.
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Objective:To study the treatment outcomes of transjugular intrahepatic portal shunt (TIPS) on refractory hepatic sinus obstruction syndrome (HSOS) caused by Gynura segetum.Methods:The clinical data of 15 patients with refractory HSOS caused by Gynura segetum treated at the Department of Vascular Surgery, Henan Provincial People's Hospital from January 2017 to April 2021 were retrospectively analyzed. There were 7 males and 8 females, with ages ranging from 30 to 85 years, mean ± s. d. (61.2±14.1) years. Albumin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, glutamyl transferase, and portal vein pressure were compared before and after TIPS. The liver function and renal function of these patients were followed up.Results:When compared with pre-operation, the albumin, alanine aminotransferase, aspartate aminotransferase and other indexes were significantly improved after TIPS (all P<0.05). The portal vein pressure of 15 patients significantly decreased from the preoperative volume of (41.7±3.5) cmH 2O (1 cmH 2O=0.098 kPa) to (28.3±4.4) cmH 2O ( t=10.41, P<0.001). The preoperative liver function was Child-Pugh grade A in 1 patient, grade B in 8 patients, grade C in 6 patients. The postoperative Child-Pugh grading was grade A in 14 patients and grade B in 1 patient. Ascites, gastrointestinal bleeding, abdominal pain, abdominal distention and spontaneous peritonitis all disappeared in these 15 patients. Postoperative hepatic encephalopathy developed in 2 patients and hepatic myelopathy in 1 patient. Conclusion:TIPS for treatment of HSOS caused by Gynura segetum resulted in a rapid recovery of liver function, rapid symptomatic relief, with a low incidence of hepatic encephalopathy/hepatic myelopathy.
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ObjectiveTo investigate the technical success rate and outcome of transjugular intrahepatic portosystemic shunt (TIPS) in preventing esophageal variceal rebleeding in patients with portal vein thrombosis (PVT) after splenectomy. MethodsA retrospective analysis was performed for the clinical data of 46 patients with PVT after splenectomy who were admitted to Shandong Provincial Hospital from December 2009 to January 2017 and underwent TIPS to prevent esophageal variceal rebleeding. According to the success or failure of TIPS, the patients were divided into TIPS success group with 38 patients and TIPS failure group with 8 patients. The two groups were compared in terms of postoperative variceal rebleeding, stent dysfunction, hepatic encephalopathy (HE), and survival. The paired t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier curve was used to analyze variceal rebleeding-free rate, stent patency rate, HE-free rate, and survival rate, and the log-rank test was used for comparison of cumulative rebleeding-free rate and cumulative survival rate. ResultsThe technical success rate of TIPS was 82.6%. There were significant differences in 6-, 12-, and 24-month cumulative rebleeding-free rates between the TIPS success group and the TIPS failure group (94.3%/89.8%/89.8% vs 85.7%/85.7%/28.6%, χ2=4.563, P=0.033). In the TIPS success group, the 6-, 12-, and 24-month cumulative stent patency rates were 79.3%, 74.3%, and 69.0%, respectively, and the 6-, 12-, and 24-month cumulative HE-free rates after TIPS were 72.1%, 55.5%, and 55.5%, respectively. There were significant differences in 6-, 12-, and 24-month cumulative survival rates between the TIPS success group and the TIPS failure group (94.0%/94.0%/86.2% vs 714%/71.4%/71.4%, χ2=4.988, P=0.026). ConclusionTIPS is a safe and feasible method for preventing esophageal variceal rebleeding in patients with PVT after splenectomy, and TIPS combined with a percutaneous transhepatic approach may promote technical success.
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Objective To study the clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with agitation thrombolysis in treatment of acute portal vein thrombosis (PVT) in patients with liver cirrhosis.Methods The clinical data of 37 cirrhotic patients with acute PVT treated from January 2014 to December 2017 at the First Affiliated Hospital of Henan University of Science and Technology was analyzed.There were 20 males and 17 females with age ranging from 29 to 71 years.The patients were divided into the combined group (n =15) and the anticoagulation group (n =22).The combined group was treated with TIPS combined with agitation thrombolysis anticoagulation.The anticoagulation group was treated with anticoagulation.The changes in liver function and hemodynamics of portal vein of the two group were compared.Follow-up studies included postoperative portal vein patency,bleeding and survival rates of patients.Results The postoperative portal vein pressure and maximum burden of PVT in the combined group were significantly lower than those before operation,and the portal vein maximum blood volume and flow velocity of portal vein were significantly higher than those before operation (all P ＜ 0.05).At 2 weeks,6 months and 12 months after operation,the maximum burden of PVT of the combined group was (13.9 ±5.4)％,(16.1 ±5.5)％ and (13.8 ±6.2)％,respectively,which was significantly lower than that of the anticoagulant group (84.1±31.3)％,(85.9±27.6)％ and (88.2±39.5)％ (all P＜0.05).At 2 weeks,6 months and 12 months after operation,the flow velocity of portal vein of the combined group was (21.6 ± 5.7) cm/s,(16.1 ± 6.3) crn/s and (17.6 ± 4.9) cm/s,respectively,which was significantly higher than that of the anticoagulation group (9.7 ± 4.6) cm/s,(8.1 ± 4.3) cm/s and (8.2 ± 3.5) cm/s (all P ＜ 0.05).After operation,3 patients in the combined group developed recurrence of portal vein thrombosis,while the remaining patients had smooth blood flow in the portal vein and shunt.In the anticoagulation group,only 3 patients had unobstructed portal vein blood flow.The cumulative rate of no gastrointes tinal bleeding in the combined group was significantly better than the anticoagulant group.The cumulative survival rate of the combined group was also significantly better than the anticoagulation group (P ＜ 0.05).Conclusion TIPS combined with agitation thrombolysis was more effective than the traditional anticoagulant therapy in treatment of acute portal vein thrombosis in cirrhotic patients.
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Objective To evaluate the clinical efficacy of transjugular intrahepatic portosystem shunt (TIPS) and gastric coronary vein embolization (GCVE) in the treatment of patients with cirrhosis,portal hypertension and upper gastrointestinal bleeding.Methods From Jan 2014 to May 2017 72 patients were enrolled and divided into the TIPS group (36 cases,receiving TIPS) and TIPS + E group (36 cases,byTIPS+GCVE).Results Portal vein diameter (1.21 ±0.08)cm vs.(1.26 ±0.09)cm,portal pressure (23.9 ± 2.1) cmH2O vs.(25.1 ± 2.2) cmH2O and congestion index (0.06 ± 0.03) cm/s vs.(0.08 ±0.03) after 1 month of treatment in TIPS + E group was significantly lower than the TIPS group,and the portal vein velocity was significantly higher than that of the TIPS group (42 ± 6) cm/s vs.(38 ± 7) cm/s,t =2.491,2.367,2.828,t =2.343,all P ＜ 0.05.The Child-Pugh score in the TIPS + E group was significantly lower than that in the TIPS group (7.9 ± 1.4) vs.8.6 ± 1.6,t =2.074,P =0.042).There was no statisticall different difference in postoperative hepatic encephalopathy in the two groups (17％ vs.11％,x2 =0.465,P =0.496).The one-year rebleeding rates in the TIPS group and the TIPS + E group were 14％ and 3％,respectively.The risk of rebleeding in the TIPS + E group was significantly lower than that in the TIPS group (HR =0.218,P =0.041).The one-year access obstruction rates in the TIPS group and the TIPS + E group were 17％ and 14％,respectively.(P =0.679).The all-cause mortality rates of the TIPS group and the TIPS + E group were 8％ and 3％,respectively,showing no statistically (P =0.299).Conclusions TIPS + GCVE therapy in the treatment of portal hypertensive upper gastrointestinal bleeding effectively reduces the risk of rebleeding.
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Objective :To observe clinical effect of Viatorr stents in TIPS for treatment of portal hypertension. Methods Thirty-four portal hypertension patients who underwent TIPS using Viatorr stents were collected. The portal vein pressure, the incidence of hepatic encephalopathy and patency rate of shunt were analyzed. Results TIPS was successfully performed using Viatorr stent, the technical success rate was 100%. The preoperative and postoperative portal pressures were (40.00±3.85)cmH2O and (23.60±2.87)cmH2O, respectively. During 1 to 14 months' follow-up, the patency rate of shunt was 100% (34/34), and the incidence of hepatic encephalopathy was 5.88% (2/34). Conclusion :Viatorr TIPS for treatment of portal hypertension has high operative success rate, high shunt patency rate and low incidence of hepatic encephalopathy.
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Hepatic encephalopathy (HE) can cause a wide spectrum of neurological or psychological impairment. The high incidence of HE after transjugular intrahepatic portosystemic shunt (TIPS) severely restricts its use in the treatment of portal hypertension. The progress of pathogenesis, risk factors and management of post-TIPS HE were mainly reviewed in this article.
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Objective: To analyze the prognostic factors of transjugular intrahepatic portosystemic shunt (TIPS) in treatment of esophageal and gastric varices bleeding (EGVB). Methods: A retrospective analysis was performed on 68 patients with EGVB who underwent TIPS. Kaplan-Meier method was used to calculate the cumulative survival after treatment, and the differences of cumulative survival were compared using log-rank test. Multivariate analysis of prognostic factors was carried out with Cox proportional hazards regression model, and ROC curve was used to determine the optimal cut-off value of prognostic factors. Results: The 1-, 2- and 3-year survival rate was 90.7%, 82.2% and 77.9% respectively after TIPS procedures. Cox regression univariate and multivariate analysis showed that the age (P=0.009) and preoperative serum albumin (P=0.024) were independent prognostic factors. The area under the ROC curve of age for assessing whether the survival time more than 1 year was 0.923 (P=0.001), while that of preoperative serum albumin was 0.183 (P=0.011). Patient's age of 67.5 years was the optimal cut-off value. The 1-year cumulative survival rate of patients' aged ≤67.5 years was statistically significant higher than that of those older than 67.5 years (96.4% vs 64.3%, χ2=10.785, P=0.001). Conclusion: Patients' age and preoperative serum albumin are independent predictors for the survival of EGVB after TIPS. Postoperative prognosis of patients' aged >67.5 years is unfavorable.
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Objective: To explore the effects of Interlock controllable spring coils for limiting blood flow of TIPS shunt in refractory hepatic encephalopathy patient after TIPS. Methods: Interlock controllable spring coils were used to restrict shunt flow in 5 patients with refractory hepatic encephalopathy after TIPS operation. Results: Totally 7 controllable spring coils were implanted in all 5 cases, including 3 coils of 10 mm×25 cm, 1 coil of 15 mm×25 cm and 3 coils of 10 mm×40 cm. Combined with symptomatic treatment after TIPS, the symptoms of hepatic encephalopathy were significantly improved in 1 patient, while in 2 patients recurrent hepatic encephalopathy symptoms were observed within 2 months after restriction and disappeared after the second restriction. In 2 patients with symptoms of portal vein hypertension 2 weeks after the first restriction, 8 mm×60 mm balloon was selected to expand the shunt channel, and then 8 mm×60 mm Nitinol alloy stent was implanted in each one, and no symptom of hepatic encephalopathy nor portal vein hypertension occurred after the stent implantation. Conclusion: It is safe and reliable to treat refractory hepatic encephalopathy after TIPS (5 cases) with coils implantation for limiting blood flow.
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Liver three-dimensional technology provides decision-making reference for preoperative assessment,intraoperative simulation,and individualized surgical planning.Compared with traditional imaging techniques,the three-dimensional reconstruction technique of the liver performs real-time three-dimensional image analysis of complex liver tissue,and displays the patient's lesions and surrounding organs and blood vessel structures in three dimensions.This technology opened a new page for liver interventional surgery,especially for the successful implementation of trans-jugular intrahepatic portosystemic shunt (TIPS).This article describes the research progress of liver three-dimensional reconstruction technology and its application in TIPS surgery.
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Transjugular intrahepatic portosystemic shunt (TIPS) is a surgery which was commonly used in portal hypertension therapy.It can control and prevent the complication caused by portal hypertension,such as esophageal gastric-fundus variceal bleeding.However,there is a fundamental flaw in the TIPS due to its lack of maintaining a long-lasting and effective shunt,and most of the stenosis or occlusion are in the draining vein:the hepatic vein.Accompanied by direct intrahepatic portosystemic shunt (DIPS),which has shown its advantage compared with traditional TIPS operation,such as the block of hepatic vein can be avoided,the radiation dose as well as the operation time is lesser,DIPS is safer and so on.Here we reviewed to present a brief introduction of DIPS development history and core concerns of the major medical centers at present.
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Objective To explore the feasibility of fusion image of Xper-CT and CT portal venography (CTPV) as DSA 3D-roadmap in operation of transjugular intrahepatic portosystemic stent shunt (TIPS).Methods Thirty-seven patients with portal hypertension were enrolled in this study,among them 21 underwent conventional TIPS retrospectively,16 underwent Xper-CT and CTPV imaging to obtain fusion image in the workstation with the software of Multi-Modality Matching for hepatic portal vein without contrast medium administration.Then the fusion image was used as the 3D-roadmap in the process of real-time fluoroscopy.Results In the fusion process of Xper-CT and CTPV,osseous registration error was ＜ 2.00 mm,while error of the portal vein fusion image and the real-time X-ray image displacement were ＞2.00 mm between up and down in 15 patients,＞5.00 mm between left and right in 1 patient.Conclusion Xper-CT with CTPV fusion image can be used as 3D-roadmap of TIPS to observe the relationship between puncture needle and the portal vein without administration of contrast medium,improving the accuracy and safety of puncture and reducing operation time.
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Transjugular intrahepatic portosystemic shunts (TIPS) are widely used in the management of bleeding gastric varices (GV). More recently, several studies have demonstrated balloon-occluded retrograde transvenous obliteration (BRTO) as an effective treatment method for bleeding isolated GV, especially in patients with contraindications for a TIPS placement. Both TIPS and BRTO can effectively treat bleeding GV with low rebleeding rates. Careful patient selection for TIPS and BRTO procedures is required to best treat the patient's individual clinical situation.
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Humans , Balloon Occlusion , Embolization, Therapeutic , Esophageal and Gastric Varices , Hemorrhage , Methods , Patient Selection , Portasystemic Shunt, Surgical , Portasystemic Shunt, Transjugular IntrahepaticABSTRACT
Summary of Event: A transjugular intrahepatic portosystemic shunt (TIPS) stent (Viatorr) was misplaced into main portal vein and superior mesenteric vein. This misplaced covered stent was then successfully retrieved using the rigid endobronchial forceps. Teaching Point: Before release the covered portion of the TIPS stent (Viatorr), it is necessary to confirm the position of uncovered portion in portal vein and covered portion in parenchymal tract. The endobronchial forceps technique is a safe and efficient method for retrieving a misplaced TIPS stent.
Subject(s)
Device Removal , Mesenteric Veins , Methods , Portal Vein , Portasystemic Shunt, Surgical , Portasystemic Shunt, Transjugular Intrahepatic , Stents , Surgical InstrumentsABSTRACT
ObjectiveTo investigate the effect of antiviral therapy on the prognosis of patients with decompensated hepatitis B cirrhosis who underwent transjugular intrahepatic portosystemic shunt (TIPS). MethodsThe clinical data of 110 patients with decompensated hepatitis B cirrhosis who underwent TIPS to prevent variceal rebleeding from January 2008 to December 2011 were analyzed retrospectively, and based on whether they used antiviral drugs or not, these patients were divided into TIPS-antiviral drug group (58 patients) and TIPS group (52 patients). The t-test or Wilcoxon rank sum test was applied for comparison of continuous data between the two groups, and the chi-square test was applied for comparison of categorical data between the two groups. The Kaplan-Meier survival analysis and log-rank test were performed to analyze the cumulative survival rate, rebleeding rate, stent patency rate, and incidence of hepatocellular carcinoma (HCC). ResultsThe 1-, 3-, and 5-year cumulative survival rates after TIPS in the TIPS-antiviral drug group versus the TIPS group were 93.1% vs 88.5%, 86.1% vs 64.9%, and 77.7% vs 59.7%, respectively, and the TIPS-antiviral drug group had a significantly higher cumulative survival rate than the TIPS group (χ2=6.833, P=0.009). In the TIPS-antiviral drug group, the virologic response rate increased with the prolonged time of antiviral therapy. The cumulative variceal rebleeding rate, stent patency rate, and incidence of HCC showed no significant differences between the two groups (all P＞0.05). ConclusionAntiviral therapy can improve the survival rate of patients with decompensated hepatitis B cirrhosis after TIPS.
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Objective To explore the clinical characteristics of patients with transjugular intrahepatic portosystemic shunt (TIPS) and literature review in patients with clinical features ,and provide clinical reference for carrying out the TIPS .Methods Totally 31 patients in our hospital from January 2009 to May 2014 who received TIPS treatment and strict follow‐up were retro‐spectively analyzed ,the preoperative basic situation ,laboratory index ,the incidence of postoperative bleeding again ,surgical compli‐cations ,the use of anticoagulant drugs and thrombosis ,dissolved ,etc .were statistical analyzed .Results In all patients with TIPS in the diagnosis of cirrhosis and portal hypertension ,hepatitis B ,hepatitis C cirrhosis and portal hypertension ,alcoholic liver cirrhosis and portal hypertension ,unknown cause of liver cirrhosis and portal hypertension ,Budd Chiari syndrome ,hepatitis B and hepatitis C cirrhosis and portal hypertension ,primary biliary cirrhosis and portal hypertension in proportion of 45 .16% ,16 .13% ,12 .90% , 12 .90% ,6 .45% ,3 .22% ,3 .22% respectively ;the incidence of postoperative bleeding again within six months was 9 .68% ;the Child‐Puhg score of preoperative and postoperative 1 week and 3 months ,6 months was (8 .35 ± 2 .52) ,(8 .32 ± 1 .76) ,(9 .29 ± 2 .55) ,(8 .10 ± 1 .85) respectively .Statistical results showed in postoperative 1 week and 3 months ,6 months ,there was no statisti‐cally significant difference compared with preoperative respectively (P>0 .05) ,postoperative 3 months liver function score of Child‐Puhg was higher than that of postoperative 1 week and 6 months (P<0 .05) operation;the rate of abdominal hemorrhage ,hepatic encephalopathy ,stent stenosis were 3 .22% ,22 .58% ,12 .90% ;the proportion of no postoperative taking anticoagulants ,taking as‐pirin ,clopidogrel ,and warfarin were 9 .68% ,38 .71% ,41 .94% ,9 .68% ,respectively ;the formation of portal vein thrombosis (inclu‐ding thrombosis increased) rate was 12 .90% ,thrombus dissolution rate was 100% .Conclusion In China ,liver cirrhosis and portal hypertension is the main source of TIPS and hepatitis B is a major cause of liver cirrhosis ;TIPS have no effect on liver function in Child‐Puhg score;hepatic encephalopathy ,stent restenosis is still the main postoperative complications of TIPS ;rules taking antico‐agulant drugs can dissolve thrombus of the portal vein and prevent thrombosis .
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Spontaneous portosystemic shunt (SPSS) has not yet drawn enough attention. The incidence of SPSS in cirrhotic patients is 38%-40%, and 46%-70% of cirrhotic patients with refractory encephalopathy show SPSS. Embolization of SPSS may be a safe and effective method for the treatment of refractory encephalopathy in patients with cirrhosis. The critical role of transjugular intrahepatic portosystemic shunt (TIPS) in the prevention and treatment of the complications of portal hypertension has been demonstrated. To further reduce portal pressure and prevent gastroesophageal variceal rebleeding, TIPS is essential for the treatment of cirrhotic patients with SPSS. Meanwhile, TIPS with SPSS embolization may reduce the post-TIPS complications, and the patients may benefit more from TIPS. Prospective randomized controlled trials are warranted to further confirm these findings.
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Objective To investigate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) with covered stent in the treatment of portal hypertension in patients with hepatocellular carcinoma.Methods The clinical data of 46 patients with primary hepatocellular carcinoma and portal hypertension who received TIPS with stent treatment were retrospectively analyzed.After treatment,liver function,shunt patency,re-bleeding rate,hepatic encephalopathy,ascites,gastric intestinal symptoms, lifetime and causes of death were analyzed. Compare t test was performed for measurement data comparison among groups.The survival curves were used to analyse the cumulative stent shunt patency rate,the incidence of hepatic encephalopathy and the survival rate.Results After the operation,portal vein pressure significantly decreased compared with that before operation [(16.2 ± 4.6 )mmHg vs (28.3±5 .1)mmHg,1 mmHg=0.133 kPa],and the difference was statistically significant (t =21 .30, P 0.05].Cumulative stent shunt patency at 3,6,12,24,36 month after operation was 100.0%,95 .6%,93.5 %,91 .3% and 91 .3%,respectively.The cumulative incidence of hepatic encephalopathy was 6.5 %,8.7%,13.0%,17.4% and 26.1 %,respectively;cumulative survival rate was 95 .7%,82.6%,67.4%,43.5 % and 32.6%,respectively.In 10 cases of refractory ascites, ascites of all the patients reduced with different degree after operation and gastrointestinal uncomfortable symptoms were relieved.Conclusion In patients with primary hepatocellular carcinoma and portal hypertension,who have gastrointestinal bleeding or refractory ascites,treatment of TIPS with covered stents could effectively lower portal pressure,prevent re-bleeding and reduce the volume of ascites.