TIPS Combined With EGVE For The Treatment Of Poital Hypertension With Gastrointestinal Bleeding:A Clinical Study Of Different Embolization Materials

Objective:To investigate the application of transjugular intrahepatic portosystemic shunt(TIPS)combined with esophagogastric varices embolization(EGVE),tissue glue and coils as embolic material for portal hypertension.The prognosis and pros and cons of patients with esophageal varices bleeding provide reference for the selection of EGVE embolization materials.Materials and Methods:1.Retrospective analysis of single-center patients from April 2015 to June 2018 with TIPS combined with EGVE in the treatment of portal hypertension with gastrointestinal bleeding.2.Twenty three patients with concurrent tumors and 43 patients with bare or bare stent plus stent graft were excluded to eliminate the influence of tumor and stent type on the target and prognosis.3.Patients were followed up at 1,3,6 and 12 months after the procedure and then every 6M.During the follow-up period,patients were revisited at any time when their conditions changed.4.One hundred twenty one patients with complete data were divided into three groups of ABC.Group A was 58 cases of TIPS combined with N-butyl 2-cyanoacrylate(NBCA)group,and group B was Twenty-one patients in with NBCA+Coil,and 42 patients in the TIPS combined with the Coils group as group C.5.Observed indicators:patient laboratory indicators(blood routine,liver and kidney function,coagulation function,blood ammonia),imaging examination data,clinical manifestations,physical examination,and shunt function(color Doppler examination to confirm stent patency),The patient's clinical manifestations and examination indexes were recorded in detail,and the rebleeding rate,liver function changes,complications,mortality,and surgical costs of the three groups were compared.6.Statistical analysis:Using SPSS 19.0 statistical software,the measurement data were expressed as mean± standard deviation((x±s),age,Child-pugh score,Meld score,follow-up time by one-way analysis of variance;cirrhosis induced,Liver function grading,stent length,other treatments before TIPS,and complication rate were performed by Fisher test,comparison of counting data between groups was conducted by chi-square test,follow-up time and KW test for embolic material,and survival rate was compared by Kaplan-Meier analysis,P<0.05 indicates that the difference is statistically significant.Results1.The follow-up time of all patients ranged from 1 to 37 months.The mean follow-up time was 14.1 months.The median follow-up time was 14.7 months.The mean follow-up time of TIPS combined with NBCA was 13.7 months.The median follow-up time was 15.3 months.The average follow-up time was 15.6 months in group B,the median follow-up time was 14.8 months.The average follow-up time was 12.8 months with Coil as the embolic agent group.,the median follow-up time was 15.7 month.2.At the 12-month follow-up,the rebleeding rate was 5.2%in the NBCA group,4.8%in the NBCA+Coil group,and 7.1%in the Coil group.There were no statistics difference between the three groups.The difference was(P=0.897);the 1 year survival rates were 96.6%?95.2%and95.2%respectively(P=0.936).3.In comparing of different embolic material costs,it was found that there was significant difference between the NBCA group and the B,C group(P<0.05).There was no significant difference between the B,C group.The average cost of embolization materials in the three groups of ABC patients was:? 2129.5 VS Y 6520.4 VS? 6683.6 respectively.4.The incidence of hepatic encephalopathy took place in the three groups of A,B and C group was 20.7%,14.3%,and 16.7%,respectively,with no significant difference(P=0.769).In the group A,two patients endured shunt dysfunction,In the group C,one patient endured shunt dysfunction.The overall incidence of complications in three groups has no statistically significant(P=0.897).Conclusions:1.TIPS combined with EGVE is an safe and effective procedure on the treatment of patients with cirrhosis and EGVB;2.There is no significant difference in postprocedure bleeding rate,mortality,and complication's rate among the three groups.3.The cost of procedure of NBCA group is significantly lower than that of the other two groups,and it has advantages over the other two groups in fluoroscopy time and procedure time.Therefore,under the premise of mature technology,NBCA may be a more ideal embolic agent in TIPS combined with EGVE.