Clinical Studies On TIPS And Joint GCVE And PSE Treatment Of Portal Hypertension And Upper Gastrointestinal Bleeding

Objects:This paper analyzes retrospectively clinical data of treatment of PSE portal hypertension and upper gastrointestinal bleeding by either24cases of TIPS+GCVE or20cases of TIPS+GCVE joint PSE. Comparison of changes of portal venous hematodynamics, splenic hemodynamics, liver function, blood routine, and gastrointestinal varices between two surgical methods is performed. We also compare rates of gastrointestinal bleeding, shunt patency, incidence of hepatic encephalopathy and complication in both methods. The effects applications of TIPS+GCVE joint PSE on the treatment of cirrhotic portal hypertension and upper gastrointestinal hemorrhage) is analyzed.Materials and Methods:Collect44cases of surgical patients with TIPs during April,2010and April,2013, and divides them into two groupsaccording to surgical methods, group A with(TIPS+GCVE) and group B(with PSE after TIPS+GCVE). Contrast between two methods of portal vein pressure before and after operations; Contrast of the renal arterial diameters、sectional area、maximum velocity of the average blood flow velocity, splenic venous congestion index, spleen length to diameter, thickness before and one week, one month,3months,6months,12months after operations between two techniques. Gastroscopy preoperative levels of postoperative gastrointestinal varicose veins.Record changes of Gastrointestinal varicose veins after gastroscopic diagnosis. Contrast of ALT、 AST、ALB、TBIL、PLT、PT before and12-48hours,1months,3months,6months, and12months between two groups; Follow up rebleeding rates, Shunt patency, and complication after operations in both groups. Application of SPSS17statistical software was used for data processing, the measurement data with X±s mean, variance analysis with general data of patients, liver function test with Kruskal-Wallis method; count data using x2test, between the two groups were compared using the paired t test, the above statistical results of P<0.05had statistical significance.Result:1、Operations on all the44cases were successful, with a success rate of100percent and a bleeding control rate of100percent.2、 According to radiography and liver function, stent shunt coverages with diameters of8mm were used in TIPs (46covered stents,8bare stents, in34cases every patient used1covered stents, and in2cases every patient used2covered stents, in8cases every patient used1covered stents and1bare stent).3、 Appropriate embolus GCVE was used when radiography showed medium or severe esophageal and gastric varices.4、PSE:B group of10patients underwent PSE during the operation,10cases of patients underwent PSE in a week5、Main portal vein pressure (cmH2O) decreased from (44.3±5.9) before operations to (26.1±3.5)after operations in group A, from(44.9±5.7)to (22.5±3.4)in group B. Contrastswithin a group and between two groups has statisticalsignificance(P<0.5).6、Portal trunk diameter decreased from (1.62±0.08)before operations to(1.27±0.07) after operations in group A, and from(1.61±0.09) to (1.03±0.06)in group B. Contrasts within a group and between two groups has statistical significance(P<0.5).7、Blood velocity in portal vein(cm/s) increased from (7.5±4.6)before operations to (20.5±4.6) after operations in group A, and from (6.9±4.6to (25.6±4.4)in group B. Contrasts within a group and between two groups has stactical significance.8、Heal rates after operations were66.6%(12cases) for group A and94.2%(18cases) for group B repectively, and contrasts has statistical significance(P<0.5);9、the rate of gastrointestinal bleeding in3months after operations is1case(4.1%) for group A and1case for (group B), then differences between two groups has no statistical significance (P>0.05); the rate of gastrointestinal bleeding in6months after operations is3cases(14%) for group A and3cases for (group B), then difference between two groups has statistical significance (P<0.05);10、rate of gastrointestinal bleeding in6months after operations is3cases(14%) for group A and3cases for (group B), then difference between two groups has statistical significance (P<0.05);11、The incidence of hepatic encephalopathyin6months after operations was4cases (16.7%) for group A, and19(95%) for group B, no obvious difference exited (P>0.05).12、Splenic venous congestion index reduced from (0.093±0.045)before operations to (0.027±0.013)for group A, and from(0.104±0.059) to (0.019±0.006)for group B. Differences both within a group and between groups have statistical significance (P<0.05).For group A, changes in diameters of spleen veins after operations has no statistical significance (P>0.05). Differences with group B and between group A and group B have statistical significance (P<0.05).13, spleen diameter (CM):there was no significant difference in A group before and after operation (P>0.05), B group (16.83±2.94) preoperative to postoperative (12.32±3.41), within group and between group differences were statistically significant (P<0.05).14, the thickness of spleen (CM):there was no significant difference in A group before and after operation (P>0.05), B group (7.34±2.03) preoperative to postoperative (6.89±1.68), within group and between group differences were statistically significant (P<0.05).15、Contrasts between two groups in1week after operations shows that, there was no obvious difference in WB、ALT、AST、ALB、TBIL、 PLT、cholinesterase、albumin (P>0.05).In group B, counts of WBCs PLT、ALB. PCHE raised apparently after partial splenicembolism(PSE). Differences had statistical significance (P<0.05), and differences compared with group A during the same period had statistical significance(P<0.05).Conclusion:1) TIPS+GCVE and TIPS+GCVE+PSE can effectively decrease portal pressure, bleeding control rate of100%. Improving hypersplenism not obvious application of8mm scaffold with GCVE during TIPS. Combined with PSE, can significantly improve the spleen function hyperfunction.2) TIPS+GCVE+PSE12months after operation of esophageal varices improvement rate is better than that of TIPS+GCVE;3months after the hemorrhage rate less than TIPS+GCVE.3) Improvement of cholinesterase, albumin TIPS+GCVE+PSE obviously.4) TIPS+GCVE+PSE on postoperative shunt patency without obvious effect.5) And mild fever, severe abdominal pain for most patients with TIPS+GCVE+PSE, but to improve or improved after symptomatic treatment in a week or so, serious complications and no splenic abscess, spleen rupture.