Clinical efficacy of transjugular intrahepatic portosystemic shunt in the treatment of upper gastrointestinal bleeding in patients with hepatocirrhosis / 天津医药

ABSTRACT

@#To explore the clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of upper gastrointestinal bleeding in patients with hepatocirrhosis. Methods Totally 75 hepatocirrhosis patients with upper gastrointestinal bleeding accepted TIPS treatment in our institution from March 2012-March 2017 were collected retrospectively in this study. Patients were divided into two groups, the control group (n=35) underwent conservative treatment, and the TIPS group (n=75) received TIPS treatment on the basis of conservative therapy. Indexes of portal venous pressure, portal vein diameter, portal velocity, platelet count (PLT), erythrocyte count (RBC), albumin (ALB), total bilirubin (TBIL), glutamic-pyruvic transaminase (ALT), and glutamic-oxalacetic transaminase (AST) before and after operation were compared between two groups. Data of survival rate, rehaemorrhage rate and living quality after the operation were followed up, and which were compared between the two groups. Results Totally 75 patients received TIPS and were all successful, with the technical success rate 100%. There were no patients died during the perioperative period. No serious complications such as cardiac tamponade, hematocelia and biliary fistula were found. Compared with pre-operation, portal venous pressure and portal vein diameter were significantly decreased, and portal velocity was increased after operation (P＜0.05). Totally 11 patients were dead during the follow-up period, with fatality rate 14.7%. Original unobstructed rate of TIPS runner at 3, 6, 12, 24 and 36 months were 95.6%, 90.1%, 85.7%, 79.0%, and 74.2% respectively. Compared with pre-operation, indexes of PLT, RBC and ALB at 6 months after surgery were improved (P＜0.05). Whereas there were no significant differences in TBIL, ALT and AST before and after operation (P＞0.05). There were no significant differences in accumulate survival rates at 3, 6, 12, 24 and 36 months between control group (94.3%, 91.3%, 75.8%, 71.0%, and 59.2% respectively) and TIPS group (98.7%, 97.3%, 95.7%, 83.4%, and 70.6% respectively, Log-rank χ2=2.743, P=0.098). Accumulate rehaemorrhage rates at 3, 6, 12, 24, and 36 months were 5.7%, 17.1%, 23.5%, 31.9%, and 43.2% respectively in the control group, and they were 2.7%, 4.0%, 8.3%, 14.4%, and 24.0% respectively in the TIPS group. There were significant differences in accumulate rehaemorrhage rates between the two groups (Log-rank χ2=4.608, P=0.032). Compared with control group, indicators of living quality were improved at 6 months after surgery in the TIPS group (P＜0.05). Conclusion TIPS is safe and effective for cirrhosis patients with upper gastrointestinal bleeding. Compared with conservative treatment, TIPS can decrease rehaemorrhage rate and improve living quality of patients.