The Causes And Prevention Strategies Of Gastrointestinal Rebleeding After TIPS

Objective:Analysis using the transjugular intrahepatic portasystemic shunt (TIPS) in patients with cirrhosis portal hypertension and esophageal and gastric varicealbleeding after rebleeding of upper gastrointestinal.To explore the treatment measures and prevention strategy after rebleeding.Methods:A retrospective analysis method, collected in 2006 January to December 2014 Second Affiliated Hospitalof Kunming Medical University, the use of TIPS in the treatment of liver cirrhosis with portal hypertension and esophageal and gastric variceal bleeding patients, a total of 177 cases.After 1,2,3,6,12,18 months,2 years,3 years,4 years,5 years follow-up, the follow-up deadline is December 31,2014, if there is a loss of follow-up patients, followed by the loss of follow-up for the end date.Emergency gastroscopy, ultrasound, CT, direct portal vein angiography were performed in patients with recurrent bleeding during follow-up, and the stent was once again placed or parallel to TIPS. A detailed record of the TIPS after operation in patients with rebleeding for the first time bleeding time, rebleeding after the treatment and analysis rebleeding and TIPS stent position, the types of stent, stent diameter and portal venous pressure of the correlation. Using SPSS 19.0 software package for statistical analysis.Results:1. The cause of rebleeding:①Stent Stent dysfunction leading to esopha geal gastric varices rebleeding; ②tent patency but esophageal gastric varices b leeding with Portal Hypertensive Gastropathy; ③Acute gastric mucosal lesion,e rosive gastritis, gastric and duodenal ulcer; ④cardiac mucosal laceration syndro me; ⑤emorrhoid or anal fissure;⑥oagulation diaorders.2.There was a difference in the number of rebleeding cases and the rate of rebleeding after TIPS in different time periods.Patients were 177 cases with in 1 month 4 cases of upper gastrointestinal bleeding occurs,rebleeding rate of 2.3%.Patients were 165 cases with in 2 month 2 cases of upper gastrointestinal bleeding occurs,rebleeding rate of 1.2%.Patients were 146 cases with in 3 month 2 cases of upper gastrointestinal bleeding occurs,rebleeding rate of 1.4%.Patients were 129 cases with in 4-6 month 10 cases of upper gastrointestinal bleeding occurs,rebleeding rate of 7.8%.Patients were 89 cases with in 7-12 month 11 cases of upper gastrointestinal bleeding occurs,rebleeding rate of 12.4%.Patients were 50 cases with in 13-18 month 5 cases of upper gastrointestinal bleeding occurs,rebleeding rate of 10%.Patients were 40 cases with in 19-24 month 4 cases of upper gastrointestinal bleeding occurs,rebleeding rate of 10%.Patients were 31 cases with in 25-36 month 7 cases of upper gastrointestinal bleeding occurs,rebleeding rate of 22.6%.Patients were 17 cases with in 37-48 month 2 cases of upper gastrointestinal bleeding occurs,rebleeding rate of 11.8%.Patients were 11 cases with in 49-60 month 3 cases of upper gastrointestinal bleeding occurs,rebleeding rate of 27.3%.3. Tips of portal vein pressure decrease amplitude≥25% group rebleeding rate is lower than the portal venous pressure decreased amplitude< 25% group(39.13%VS21.3%, P=0.01), the difference has statistical significance;After TIPS PPG< 12mmHg group of postoperative rebleeding rate is lower than the PPG>12mmHg group (13.68% VS45.12%, P=0.000), the difference was statistically significant. 4. Transjugular intrahepatic portosystemic shunt (TIPS) in puncture portal vein left the establishment of shunt tract rebleeding rate was slightly lower than that of the right branch (21.62%VS33.67%, P= 0.083), but the difference was not statistically significant. 5. The rate of rebleeding after coverd stent was lower than that of bare stent (28.8%VS60%, P=0.04), and the difference was statistically significant. 6.The diameter were 6mm,7mm,8mm,10mm stent after the rebleeding rate was 66.67%,14.29%,19.54%,41.67%; R×C chi square test, the (2=10.536, P=0.015, P< 0.05, the difference was statistically significant.Two further comparison 8mm stent rebleeding rate was less than 6mm,10mm,the difference was statistically significant(P=0.044、P=0.015; P<0.05);and compared with 7mm diameter, the difference was not statistically significant (P=0.611; P>0.05).Two further comparison 7mm stent rebleeding rate was less than 6mm,10mm,the difference was statistically significant(P=0.029、P=0.033; P<0.05).Conclusion(s):1.Stent dysfunction is the main cause of gastrointestinal rebleeding after TIPS, and the rate of stent dysfunction is higher in 4-36 months.2. TIPS 6 months after the digestive tract re bleeding rate is higher, so the monthly ultrasound and 6 months after the operation of a DSA review is essential.3. TIPS preoperative patients did not under the premise of the induced hepatic encephalopathy, PPG try to drop to below 12mmhg; portal venous pressure decreased amplitude≥25%; to reduce the postoperative rebleeding rate and prevention portal hypertensive gastropathy.4.Stent portal position, type, diameter selection:it is recommended to use 8mm stent shunt,built on the left.5. In one year after TIPS, the incidence of bleeding caused by gastric mucosal lesions was high, so it was recommended that patients in the year after the routine use of gastric acid inhibitors and gastric mucosal protective agent.