Risk Factors For Complications Of Portal Hypertension In Cirrhosis Treated By Transjugular Intrahepatic Portosystemic Shunt

ObjectiveObserve the clinical curative effect of the transjugular intrahepatic portosystemic shunt to treatment of liver cirrhosis portal hypertension,observe the TIPS postoperative liver function changes,TIPS were followed for postoperative hepatic encephalopathy and combined esophageal gastric varices bleeding,the incidence of postoperative hepatic encephalopathy and TIPS are discussed to merge the risk factors of ruptured esophageal gastric varices bleeding.MethodRetrospective analysis of 43 patients with portal hypertension treated by TIPS from April 2013 to March 2018,the main symptoms were 33 cases of upper gastrointestinal bleeding and 10 cases of refractory ascites.After 12 months of follow-up,the postoperative portal vein pressure,the incidence of hepatic encephalopathy,the incidence of postoperative esophagogastric varices bleeding,ascites remission and recurrence,and liver function changes were observed.The t-test or rank sum test was used to analyze whether the changes of portal vein pressure and liver function before and after surgery were statistically significant.ResultsForty-three patients with cirrhotic portal hypertension underwent TIPS surgery.The patient’s portal pressure decreased from 43.32±7.55mmH2 O before surgery to 30.18±5.21 mmH2 O,and the difference was statistically significant(P<0.01).All patients had impaired liver function1 month after surgery.Child-Pugh grade A patients had better recovery of liver function than Child-Pugh grade B patients.The incidence of ascites in 10 patients 12 months after operation was 11.11%.At the time of follow-up to 12 months,the cumulative incidence of hepatic encephalopathy was 18.6%.Age ≥ 60 years old was an independent risk factor for HE after TIPS(P< 0.05),and its OR value was 17.760,95% CI(1.717,183.706).At 12 months follow-up,the cumulative incidence of esophageal varices bleeding after TIPS was 11.6%.Child-Pugh score>8.5 and Irregular oral non-selective β-blockers were independent risk factors for esophageal and gastric varices bleeding after TIPS(P<0.05).The OR value of the Child-Pugh score >8.5 was 27.309,95% CI(1.525,489.058).The OR value of the irregular oral non-selective beta-blocker was 23.464,95% CI(1.298,424.141).Conclusion:1.TIPS is an effective means to treat cirrhotic portal hypertension,which can effectively reduce portal pressure.However,hepatic encephalopathy and early liver damage may occur after TIPS.2.Age ≥ 60 years old is an independent risk factor for hepatic encephalopathy after TIPS;Child-Pugh score > 8.5 and irregular oral non-selective β-blockers are esophageal varices bleeding after TIPS independent risk factors.3.TIPS will cause liver function damage in a short period of time.In patients with liver function recovery after TIPS,Child-Pugh A patients are earlier than Child-Pugh B patients,and the long-term differences need further study.