ABSTRACT
Objective To investigate the influence of the stent position in transjugular intrahepatic left branch of portal vein portosystemic shunt (TILPS) on the long-term effect.Methods The clinical data of 527 patients with upper gastrointestinal bleeding duo to portal hypertension,who were treated with TILPS during the the period from January 2012 to December 2014,were retrospectively analyzed.According to whether the stent was placed into the left branch of portal vein,the patients were divided into the study group (stent in the left branch of portal vein,n=318) and the control group (stent in the main portal vein,n=209).The success rate of surgery,the shunt channel flow dynamics,the stent patency rate,the incidence of hepatic encephalopathy,the rate of re-bleeding,etc.were compared between the two groups.Results The success rate of shunting operation was 100％ in both groups.One year after the treatment,the blood velocity and flow parameters in the shunt channel of the study group were significantly higher than those of the control group (P＜0.05).During the the follow-up period lasting for one year,the incidences of shunt channel dysfunction in the study group and in the control group were 1.26％ (4/318) and 5.74％ (12/209) respectively (P=0.003),the incidences of hepatic encephalopathy in the study group and in the control group were 0.31％ (1/318) and 4.31％ (9/209) respectively (P=0.001),and the incidences of re-bleeding in the study group and in the control group were 0.94％ (3/318) and 2.87％ (6/209) respectively (P=0.095).Conclusion During the performance of TIPS,the puncture of the left branch of portal vein and placement of the stent in the left branch of portal vein can reduce both the incidence of shunt channel dysfunction and the incidence of hepatic encephalopathy.
ABSTRACT
Objective To study the therapeutic efficacy of Rex shunt in treating pediatric patients with prehepatic portal hypertension (PHPH).Methods Five children with PHPH who were admitted from October 2014 to May 2015 were reviewed.There were three boys and two girls,with age ranging from 50 to 95.5 months [(75.8 ± 1.9) months].They all suffered from recurrent upper gastrointestinal (GI) bleeding.Their red blood cell (RBC),white blood cell (WBC) and platelet (PLT) counts were decreased,but laboratory findings revealed no liver dysfunction.Ultrasound and CT scan diagnosed cavernous transformation of portal vein (CTPV) and splenomegaly.The mean splenic length was (42.8 ± 8.2) cm.Indirect portal venography revealed patent left portal vein.All patients underwent Rex shunt and were followed up for 3 ～ 7 months.Results The mean duration of operation was (566.0 ± 39.7) min.Intraoperative bleeding varied from 10 to 50 ml.The portal pressure significantly decreased after surgery from [(25.6 ± 1.5) mmHg,1 mmHg =0.133 kPa] preoperatively to (19.2 ± 3.3) mmHg postoperatively (P ＜ 0.05).Portal venography indicated patent left portal vein after the Rex shunt.The postoperative course was uneventful in the five patients with a mean hospital stay of (26 ± 9.3) days.There was no further GI bleeding.The RBC,WBC and PLT counts increased.Ultrasound indicated patent anastomotic stomas and decreased splenic size.Conclusion A Rex shunt in treating patients with PHPH is safe,feasible and efficacious.