Analysis of technique and perioperative safety of transjugular intrahepatic porto-systemic shunt

Abstract

Objective To evaluate the technique and perioperative safety of transjugular intrahepatic porto-systemic shunt (TIPS).Methods The clinical data of 1126 liver cirrhosis and portal hypertension patients received TIPS treatment were retrospectively analyzed.Among all the patients,male 732 cases,female 394 cases,the mean age was 46.4 years.The jugular vein was punctured and the condition of hepatic vein and the inferior vena cava was showed by angiography.The portal vein was punctured and angiographied,varices veins were embolized.The tract was dilated by the balloon and stent was set.After treatment,regular observation,anticoagulant therapy and follow-up were carried out.Comparison t test was performed for measurement data.Results The over all successful rate of TIPS was 98.6％ (1110/1126),in which the successful rate of elective operation was 98.8％ (997/1009) and the successful rate of emergency operation was 96.6％ (113/117).The average portal vein pressure decreased from (3.89±0.73) kPa before operation to (2.61±0.63) kPa after operation,and the difference was statistically significant (t 44.23,P＜0.05).The tracts was created in 957 cases through hepatic vein,130 cases through inferior vena cava,and 23 cases with two TIPS tracts.Varices veins were embolized in 981 cases.A total of 145 cases had combined percutaneous transhepatic portography.The overall mortality rate was 0.6 ％ (7/1110),in which the mortality rate of elective operation was 0.4％ (4/997) and the mortality rate of emergency operation was 2.7％ (3/113).The severe complication rate was 2.0％ (22/1110),of elective operation accounted for 1.8％ (18/1009) and emergency operation accounted for 3.5％ (4/113).After six-month,12-month and 24-month follow-up,the recurrence rate was 7.8％ (65/831),17.3％ (132/763) and 26.6％ (175/657);restenosis rate was 8.5％ (71/831),23.5％ (179/763) and 32.0％ (210/657) ;and the survival rate was 98.0％ (814/831),95.4％ (728/763) and 89.6％ (589/657).Conclusion The successful rate of TIPS can be increased and the risk reduced by full preparation before operation,careful manipulation during operation,meticulous observation and timely treatment after operation. Key words: Liver cirrhosis; Hypertension, portal; Portasystemic shunt, surgical; Perioperative care