Effect of TIPS on the treatment of elderly patients with cirrhotic portal hypertension and hemody-namics / 临床外科杂志

ABSTRACT

Objective To investigate the clinical effect of transjugular intrahepatic portosystemic shunt(TIPS)on the treatment of elderly patients with liver cirrhosis induced portal hypertension(PHT)and hemodynamics. Methods A total of 158 patients with liver cirrhosis induced PHT enrolled into depart-ment of hepatobiliary surgery in Nanjing Drum Tower hospital from 2013 till now and underwent TIPS were collected into our study. The portal system hemodynamics,surgical treatment,liver function and other labo-ratory indicators were recorded and compared before and after operation. Results At one month after op-eration,the portosystemic pressure gradient 18. 51 ± 3. 09(mmHg),portal vein diameter(PVD)1. 22 ± 0. 51(cm),portal vein flow(PVF)816. 9 ± 214. 8(ml),singular value decomposition(SVD)1. 09 ± 0. 27 (cm),splenic vein flow(SVF)355. 4 ± 18. 39(ml)had decreased compared with those before operation (P < 0. 05). The portal venous flow velocity(PVV)46. 27 ± 20. 65(cm/ s)and splenic vein flow velocity (SVV)25. 26 ± 4. 17(cm/ s)had increased compared with those before operation(P < 0. 05). The liver function [total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate transaminase(AST)]had in-creased compared with those before operation(P < 0. 05). At the sixth month after operation,ATL and AST decreased gradually compared with those before treatment(P < 0. 05). Serum albumin(ALB)had no significant changes before and after operation(P > 0. 05). The plasma levels of plasma renin activity (PRA),angiotensin II(ATII)and endothelin(ET)had significantly decreased after one month post opera-tive,and the difference was statistically significant(P < 0. 05). The clinical efficacy was evaluated in 113 cases(71. 52％)as the effective,40 cases(25. 32％)as the improved and 5 cases(3. 16％)as the ineffec-tive. Conclusion TIPS can be used in the treatment of elderly patients with cirrhosis caused PHT,with the advantages of minimally invasive,reliable operation,while postoperative complications should be paid attention.