Résumé
Objective:To study the clinical effect and safety of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of liver cirrhosis with esophageal variceal bleeding.Methods:86 cases of cirrhotic patients with esophageal and gastric varices bleeding admitted in our hospital from August 2013 to April 2015 were selected and randomly divided into the control group and the observation group with 43 cases in each group.The control group underwent percutaneous transhepatic coronary vein embolization (PTVE) treatment,while the observation group were treated with TIPS.The success rate of surgery,the incidence of various complications,the long-term survival rate and the symptoms and the changes of liver function after operation were compared between the two groups of patients.Results:The portal vein pressure after operation in the observation group was significantly lower than that of the control group (P=0.00),at 3 months,6 months and 12 months after operation,the rebleeding rate in the observation group were significantly lower than that of the control group (P＜0.05),but the incidence of hepatic encephalopathy showed no significant difference between the two groups (P＞0.05);before operation and at 6 months and 12 months after operation,the Child-Pugh score,serum TBIL,DBIL levels showed no significant difference between the two groups (P＞0.05),at 3 months after operation,the Child-Pugh score,serum TBIL,DBIL levels in the observation group were significantly higher than those of the control group (P＜0.01);the 1 year survival rate showed no significant difference between two groups (P=0.72).Conclusion:TIPS could effectively improve the symptoms of varicose veins,better on liver function damage,and enhance the long-term survival high rate with high safely in the treatment of esophageal variceal bleeding in patients with cirrhosis.
Résumé
Objective To investigate the short-term and long-term effect of cornary-caval shunt accompanied by pericardial devascularization in the treatment of upper gastrointestinal bleeding caused by portal hypertension.Methods Eleven patients with portal hypertension underwent cornary-caval shunt accompanied by partial pericardial devascularization were chosen.Of the 11 patients 6 applied autogenous splenic veins for graft and in 5 cases the coronary vein and inferior vena cava were anastomosed directly.Results Of the 11 patients,no operative mortality or early rebleeding.All patients were followed up from 5 months to 11 years with an average of 5 years and 3 months,of whom two died,others having no rebleeding or hepatic encephalopathy.Conclusion Cornary-caval shunt is a highly selective portosystemic shunt.Cornary-caval shunt accompanied by pericardial devascularization is a surgical treatment of upper gastrointestinal bleeding caused by portal hypertension for its apparent regional antihypertensive effect,the normal blood flow of liver,and reduction of the incidence of rebleeding.