A Study On The Clinical Efficacy And Value Of TIPS In The Treatment Of Cirrhosis Complicated With Portal Vein Thrombosis

Objectives: To study the clinical efficacy of TIPS in the treatment of cirrhosis with portal vein thrombosis,including the improvement of clinical symptoms and the prognosis of thrombosis.And to enrich the clinical evidence for TIPS treatment in such patients.Methods: From April 2013 to November 2017,17 patients with cirrhosis and portal vein thrombosis treated by TIPS in our hospital were retrospectively analyzed.The patients were followed up for 1 to 12 months to observe the outcome of thrombosis,the functional status of stent and the improvement of clinical symptoms.Results: All 17 patients were operated successfully.The technical success rate was 100%and the average portosystemic pressure gradient was reduced to 10.5 mm Hg after operation.One patient died of severe hepatic encephalopathy 1 month after TIPS,another died of cerebral hemorrhage caused by hypertension 12 months after TIPS,and one developed hepatocellular carcinoma 12 months after TIPS.All 16 patients were continually followed up for 12 months except that one who died of hepatic encephalopathy 1 month after operation.During the follow-up period,The cumulative1-year shunt dysfunction rates was 23.5%(4/17).The cumulative 1-year variceal re-bleeding rates was 11.8%(2/17).Most patients did not suffer from upper gastrointestinal bleeding or refractory ascites after operation.The incidence of hepatic encephalopathy was 23.5%(4/17)within 1 year after operation,and 50% patients who had hepatic encephalopathy symptoms after operation was level 1 or 2,and the symptom was mild which could be effectively treated by conservative medical treatment.The1-year cumulative survival rate of all patients was 88.2%(15/17).Among the 17 patients who were followed up,27 vessels were embolized in different degrees.The cumulative improvement rate of embolic vessels was 77.8%(21/27),The complete thrombolysis rate was 66.7%(18/27),partial thrombolysis rate was 11.1%(3/27),thrombosis stability rate was 11.1%(3/27),and thrombosis progression rate was 7.4%(2/27).The average improvement time of embolism was 2.4 months after operation,and the average time of complete dissolution was 4.4 months.Conclusion: TIPS is effective in the treatment of cirrhosis with portal vein thrombosis.It can improve the symptoms related to portal hypertension,and occlusive vessels can achieve different degrees of recanalization within months to one year after treatment.