Analysis of Hepatic Encephalopathy After TIPSS / 中国医师杂志

Objective To investigate the causes and characterization of hepatic encephalopathy after transjugular intrahepatic portosystemic shunts(TIPSS).Methods 32 cases of patients with recepted TIPSS operation were enrolled in retrospective study.Results 9 of 32 patients suffered from hepatic encephalopathy were detected out after TIPSS. The present of hepatic encephalopathy was associated with the flow direction of blood in portvein after the operation(P

Prevention and Treatment of Complications after TIPSS and Contributing Factors Analyses / 介入放射学杂志

Transjugular intrahepatic portosystemic stent shunt(TIPSS)was per- formed in 30 cases of liver cirrhosis with portal hypertention.Operations were susceeded in 29 cases with only one failure.Complications happened in 7 cases,In 29 patients the average blood bilirubin was 25.12?9.80 mmol/l before TIPSS turning to 50.46?34.50 mmol/l after TIPSS;The average blood amonia was 152.33?65.30 ?g/dl before TIPSS changing to 233.33?599.96 ?g/dl after TIPSS.The contributing factors were due to liver function state and shunting channel diameter for causing hepatic encephalopathy and jaundice.Other complications such as multipule liver abscesses,pneumonia,bacteriemia were related to the accompanied diseases and operative technique.The authors introduced the principles of pre- vention and treatment of complications,together with the indications and contraindications of TIPSS.

Combination of TIPSS and azygoportal disconnection for portal hypertension / 介入放射学杂志

Objective To investigate the clinical results of combined TIPSS and azygoportal disconnection for portal hypertension in controlling and preventing esophageal variceal bleeding. Methods From Oct. 1996 to Dec. 2001, 60 patients with portal hypertension were admitted to our department because of variceal bleeding and submitted to the treatment with the combination TIPSS and azygoportal disconnection. According to Child Pugh classification, 11 patients were in class A, 37 in class B, and 12 in class C. 41 patients showed mild ascites and 8 with severe ascites. The mild and severe esophageal varices were proven by upper digestive barium meal. The procedure was divided into two stages; first, TIPSS procedure with the stent of diameter 0.8cm and length 6-7cm was successfully inplanted in all patients, second, all patients underwent azygoportal disconnection two weeks later after TIPSS. Results After the combination TIPSS and azygoportal disconnection, the recent complications included three cases with bleeding at operative fields, one case with infradiaphagmatic abscess and seven with slight encephalopathy. No rebleeding of esophageal varices and death occurred during the treatment. During the follow up of 1-5 years, the rates of shunt occlusion, rebleeding and death were 11.9%, 3.5% and 7.0% respectively. Conclusions The combination TIPSS and azygoportal disconnection is an efficient therapeutic methods for portal hypertension.

Thrombolysis treatment of mesenteric and portal venous thrombosis by TIPSS pathway / 解放军医学杂志

Objective To evaluate the efficacy and safety of thrombolysis treatment of mesenteric and portal venous thrombosis by TIPSS pathway. Methods Six patients with thrombosis of the PV and SMV were treated by transjugular intrahepatic portosystemic shunt (TIPSS) pathway. All 6 patients presented abdominal pain, distention, and anorexia etc. No clinical signs of peritonitis were seen. The diagnosis was established by Doppler ultrasound scan and contrast enhanced CT. Control PV-SMV venography was performed after access to the PV branch. As soon as the diagnosis was established the thrombus in the PV and SMV was aspirated and fragmented. After the majority of the clot was cleared away with restoration of blood flow in the main trunk, a 4-French catheter with multiple side-holes was passed into the SMV, and urokinase (UK) was continuously infused for 3 to 13 days. Anticoagulants were given for 6 months therefter. Results The majority of the thrombus in PV and SMV was cleared away resulting in flow restoration in all patients after the procedure. Clinical improvement was seen in 5 patients, characterized by progressive alleviation of abdominal pain, distention, and diarrhea. Prior to removal of the infusion catheter from the SMV, venography revealed a complete resolution of the thrombosis in 3 patients, and residual thrombus in the PV branches in 3 cases without showing clinical symptoms. Follow-up Doppler ultrasound scan performed during 4-36 months after the procedure confirmed patency of the PV and SMV. The symptoms did not recur. Conclusions Through the TIPSS pathway, catheter-directed thrombolysis is safe and effective in the treatment of PV and SMV thrombosis.