Research Between Hepatic Encephalopathy And Hepatic Hemodynamic Changes After TIPS

Objective: To evaluate the risk factors of hepatic encephalopathy after TIPS operation.To determine whether different types of scaffolds have different effects in TIPS application.In this study,patients undergoing TIPS surgery with different stents were selected as subjects,and portal vein perfusion before and after TIPS surgery was quantitatively measured by nuclear medicine method,so as to calculate the influence of TIPS surgery on portal vein perfusion and the incidence of hepatic encephalopathy after TIPS surgery.To evaluate the relationship between hepatic encephalopathy and stent type and portal vein perfusion.The changes of liver hemodynamics and the effects of different stents on liver hemodynamics after TIPS surgery were evaluated by portal vein dynamic imaging.Methods: 1)Retrospective analysis was performed on 171 patients who underwent TIPS surgery in the interventional treatment center of the first affiliated hospital of xinjiang medical university from July 2010 to August 2018.All patients were treated with a pure bare-stent followed by a pure covered stent,a stent combination of Fluency covered stent and bare stent,or a Viatorr stent to establish an intrahepatic shunt.By analyzing the factors affecting the incidence of hepatic encephalopathy in patients,the risk factors for the incidence of hepatic encephalopathy after TIPS surgery were obtained;2)160 patients who underwent TIPS surgery in the interventional therapy center of the first affiliated hospital of xinjiang medical university from April 2014 to September 2017 were treated.All patients were treated with a combination stent or a Viatorr stent for shunt establishment through follow-up.To analyze the difference between the two groups in short-term efficacy grade and medium-term efficacy after TIPS surgery.Changes in portal vein perfusion before and after TIPS surgery,changes in portal vein pressure before and after different types of stenting,changes in portal vein perfusion before and after different types of stenting surgery,and the incidence of hepatic encephalopathy with different types of stents were compared;3)The dynamic scanning method of technetium-99 m injection before and after TIPS surgery was used to calculate the changes of portal vein perfusion before and after surgery and the effects of different stents on liver hemodynamics after TIPS surgery.Results: 1)There were many factors affecting the incidence of hepatic encephalopathy after TIPS surgery,among which age,liver function child-pugh grading and stent type were the main factors affecting the incidence of hepatic encephalopathy;2)There is a risk of hepatic encephalopathy after the establishment of shunt with different types of stents.However,the incidence of hepatic encephalopathy of different types of stents was significantly different;3)The establishment of intrahepatic shunt with Viatorr stent can reduce the incidence of hepatic encephalopathy after TIPS surgery.Different stent types are independent risk factors for the occurrence of hepatic encephalopathy after TIPS surgery(P<0.05);4)There was no significant difference in the short-term effects of combined stent and Viatorr stent on liver function after the establishment of shunt.The low incidence of postoperative hepatic encephalopathy in the Viatorr group may be related to the different effects of different types of stents on portal venous blood flow mechanics;5)The hemodynamics of portal vein changed significantly after TIPS surgery,the perfusion amount of portal vein increased significantly compared with that before surgery,and the perfusion amount of hepatic artery showed no significant difference compared with that before surgery.Total perfusion of the liver increased.Conclusion: The incidence of hepatic encephalopathy after TIPS surgery is influenced by many factors.Different types of stents have different effects on the efficacy of TIPS surgery,mainly reflected in the incidence of hepatic encephalopathy and shunt rate.The hemodynamics of the liver will change significantly after TIPS surgery.