Modified transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension of liver cirrhosis

Abstract

Objective To assess the safety and efficacy of modified transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of portal hypertension of liver cirrhosis.Methods From January 2005 to December 2009,the clinical data of 280 patients with liver cirrhosis accompanied with portal hypertension accepted TIPS treatments were collected.All the patients received liver enhanced computed tomography (CT) and hepatic blood vessel CT three-dimensional reconstruction to analyze the anatomical relationship of hepatic vein and portal vein and select the puncture location of portal vein branches.During operation,the puncture location of portal vein branches,the opening of the right hepatic vein and the distribution of portal vein branches were analyzed through directly portal vein portography.After operation safety was assessed,gastric coronary vein which caused esophageal varices was embolismed and the metal stent was implanted.Paired t-test was performed for measured data comparison before and after treatment.Mann-Whitney U or H test was used for correlation analysis between clinical data of patients and post-operation complication of TIPS and efficacy.Results Among 280 patients,TIPS operations of 278 were successfully performed and the success rate was 99.3％ (278/280).Hemoperitoneum occurred in two cases.The case number of puncture in biliary tract,gallbladder,hepatic artery and liver capsule was 10,5,8 and 18,respectively,however no hemoperitoneum or bile duct hemorrhage was observed.Among 278 cases with successful operation,198 were the right branch of portal vein puncture and 80 were the left branch puncture.By anteroposterior angiography,the location of portal vein puncture was beyond the portal vein bifurcation.Short-term hemostasis rate was 100％.The pressure of portal vein decreased from (46.5 ± 3.4) cmH2 O(1 mmH2 O =0.098 kPa) before TIPS to (26.8±3.6) cmH2O after TIPS and the difference was statistically significant (t=56.044,P＜0.01).The postoperative stent stenosis incidence was 24.1％ (67/278) at the 12th month and 34.2％ (95/278) at the 24th month.The postoperative hepatic encephalopathy rate was 18.0％ (50/278) at the 6th month and 19.1％ (53/278) at the 12th month.There were no differences in the gradient pressure of portal vein before and after TIPS,re-hemorrhage rate,hepatic encephalopathy and stent stenosis rate between patients of different etiology,gender,age,Child-Pugh classification and the puncture location (all P＞ 0.05).Conclusion The modified TIPS was safe and effective in the treatment of portal hypertension of liver cirrhosis and its complication. Key words: Portosystemic shunt; Transjugular intrahepatic; Liver cirrhosis; Hypertension, portal; Stents