| 【Objective】To explore the feasibility,effectiveness and clinica efficacy of transjugular intra-hepatic portosystemic shunt（TIPS）with the controlled dilatation stent.【Methods】The clinical data of 213 patients who received TIPS with 8 mm covered stent to establish shunt in our department from January 2013 to December 2018 were retrospectively collected.According to the method of intraoperative stent expansion,the under-dilated group adopted a method of controlled dilatation.If the preoperative portal vein pressure was≤40 cm H2O,a 6 mm balloon catheter was initially selected to dilate the shunt and the stent was implanted,ortherwise a 7 mm balloon catheter was initially choosed.After implantation of the stent,if the portal venous pressure gradient（PPG）was≥12 mm Hg or the decrease of PPG was less than 25%,then used a larger 1 mm balloon catheter to further dilate the shunt until the balloon catheter with a maximum diameter of 8 mm was used.The control group adopted a method of full dilatation.There were 55 cases and 158 cases in the under-dilated group and the control group.By propensity score matching,the patients in the under-dilated group and the control group were matched 1:1,and 53 pairs of patients were successfully matched.The changes of PPG and liver function before and after the operation were recorded.The mortality,the incidence of postoperative hepatic encephalopathy and gastrointestinal rebleeding were followed up.【Results】（1）The postoperative PPG of both groups was lower than that before operation（P<0.001）,the decrease degree of the under-dilated group and the control group were45.0%and 57.3%.The postoperative PPG of the control group was lower than the under-dilated group（P=0.012）.There was no statistically significant difference in preoperative PPG and PPG decline of both groups.（2）The alanine transaminase in the under-dilated group was lower than that in the control group at 3 and 7 days after operation（P=0.044,0.039）,and there was no statistically significant difference between the two groups in total bilirubin,albumin and aspartate transaminase at each time point.（3）Within 2 years after the operation,hepatic encephalopathy occurred in the under-dilated group and the control group were 17 cases（32.1%）and 13 cases（24.5%）.The cumulative incidence of hepatic encephalopathy in the under-dilated group after 6 months,1 year and 2 years was 26.4%,28.3%and 32.1%,and the control group was 18.9%,22.6%and 24.5%.The difference between the two groups was not statistically significant（P=0.367）.（4）Within 2 years after the operation,gastrointestinal rebleeding occurred in the under-dilated group and the control group were 5 cases（9.4%）and 10 cases（18.9%）.The cumulative incidence of gastrointestinal rebleeding in the under-dilated group after 6 months,1 year and 2 years was 7.5%,9.4%and 9.4%,and the control group was 7.5%,11.3%and 18.9%.The difference between the two groups was not statistically significant（P=0.221）.（5）A total of 20 patients died during the follow-up period,including 8 cases（15.1%）in the under-dilated group and 12 cases（22.6%）in the control group.The1-year,2-year and 3-year cumulative survival rates of the under-dilated group was92.5%,86.8%and 84.9%,and the control group was 94.3%,90.6%and 86.8%.The difference between the two groups was not statistically significant（P=0.927）.【Conclusion】The method of controlled dilatation of the stent can reduce the occurrence of sharply damaged liver function in the short term after TIPS,but there is no significant effect on liver function in the middle and long term.This method did not increase the postoperative gastrointestinal rebleeding rate,and it is open to discuss whether it can reduce the incidence of hepatic encephalopathy in the short term after surgery. |
