| Objective:Explore the safety,feasibility and clinical efficacy of transjugular intrahepatic portosystemic shunt(TIPS)for portal vein thrombosis with acute gastrointestinal bleeding.Methods:Eighteen patients with portal vein thrombosis complicated with gastrointestinal hemorrhage treated with TIPS from March 2015 to March 2017 were selected as study subjects.Color Doppler Ultrasound and/or Enhanced CT in Outpatient Follow-up at 1,3,6,12 Months after Operation for Unobstructed Portal Vein and Intrahepatic Shunt.Doppler ultrasound identified portal blood flow patency,and recorded The main diameter,blood flow direction and blood flow velocity of portal vein,and identified whether the shunt was narrow.recorded the direction and velocity of blood flow.Enhanced CT scan was performed in patients suspected of stenosis by ultrasound(thrombosis and shunting to a velocity greater than 200 cm/S or less than 20 cm/s in the portal vein trunk)or at the sixth month after surgery.Senior imaging diagnostic physicians measured multipoint contrast media filling density in portal vein,inferior vena cava and shunts.The extent of portal vein thrombosis before operation was compared to determine whether the shunt was patency and portal vein thrombosis status(disappearance,significant reduction,no progress,progress).The follow-up period was 6-24 months,with an average of 12.35 months.Results:1.All patients in this group successfully completed TIPS operation within 72 hours of massive hemorrhage of digestive tract,and the success rate of operation was 100%.A total of 34 stents were implanted.Intraoperative angiography confirmed complete thrombectomy in 4 cases,Yerdel Ⅰ in 3 cases,Yerdel Ⅱ in 1 case,accounting for 22.2%(4/18).Perioperative mortality was 5.5%(1/18).The cause of death was massive intraperitoneal hemorrhage after anticoagulation therapy.2.Postoperative grade 1-2 hepatic encephalopathy occurred in 5 cases(27.8%)(5/18).Patients received symptoms such as lactulose defecation,ornithine aspartate and branched chain amino acids.Portal vein thrombosis completely disappeared in 6 cases,significantly reduced in 7 cases,and thrombosis in 4 patients showed no significant progress.Follow-up revealed 2 cases of shunt stenosis and 1 case had rebleeding 8 months after operation.Angiography showed that the stent blood flow was still unobstructed.Stenosis was found during pressure measurement and balloon dilatation.The shunt balloon dilatation was performed and no bleeding was found during the follow-up period.Conclusions:For patients with portal vein thrombosis complicated with gastrointestinalhemorrhage,TIPS should be performed as soon as possible and regular anticoagulant therapy should be given,which is of great significance for rapid hemostasis,reducing the high mortality caused by repeated bleeding,and reducing the progress of portal vein thrombosis.Because the number of cases in this study is small,the follow-up time is short,and the thrombus load of the patients is light,whether TIPS can be used as the first-line treatment for portal vein thrombosis complicated with gastrointestinal bleeding still needs further confirmation by large sample,multi-center randomized controlled study. |
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