[Follow-up study of 116 cases of transjugular intrahepatic portosystemic shunt in the treatment of cirrhotic portal hypertension].

Objective: To investigate the incidence rate of transjugular intrahepatic portosystemic shunt (TIPS) complications in the treatment of cirrhotic portal hypertension, and analyze the cause of complication to management methods. Methods: Data of 116 patients obtained from Zhongnan Hospital of Wuhan University were retrospectively analyzed. Portal venous pressure, routine blood test, coagulation test, liver and kidney function test, ammonia blood test, imaging and endoscopy reports were collected before and after procedure. The incidence rate of hepatic encephalopathy, gastrointestinal bleeding, ascites and shunt dysfunctions were observed. Data were expressed as mean ± Standard deviation and analyzed by t-test. A chi-squared test was used for comparison between categorical variables. Results: The success rate of TIPS operation was 97.41% (113/116). Two patients underwent prompt TIPS procedure due to active bleeding. Bleeding was successfully stopped. Portal venous pressure of 113 patients decreased from (42.73 ± 7.64) cmH(2)O to (24.92 ± 7.60) cmH(2)O, and the difference was statistically significant (P < 0.01). Twenty cases were of hepatic encephalopathy. Preoperative level of Child-pugh class C patients was more susceptible to hepatic encephalopathy within 3 months after procedure than class A and B. After TIPS procedure, there were 22 cases of gastrointestinal bleeding, 18 cases of shunt dysfunctions and 26 cases of disease related death. Conclusion: Rational patient selection strategies can effectively reduce portal venous pressure, incidence of hepatic encephalopathy, improve mid-and long-term therapeutic effects, and provide opportunities for liver transplantation.目的： 探讨经颈静脉肝内门体静脉分流术（TIPS）治疗肝硬化门静脉高压症的并发症发生率，分析并发症发生原因和处理方法。 方法： 回顾性分析武汉大学中南医院116例患者资料，采集术前术后门静脉压力、血常规、凝血功能、肝肾功能、血氨、影像学及内镜检查。观察肝性脑病、消化道出血、腹水、分流道失功能等发生情况。计量资料采用均数±标准差表示，用配对t检验；计数资料组间比较采用χ(2)检验。 结果： TIPS手术成功率97.41%（113/116），2例活动性出血者行急诊TIPS均成功止血。113例患者术后门静脉压由（42.73±7.64）cmH(2)O下降至（24.92±7.60）cmH(2)O，差异有统计学意义（P<0.01）。TIPS术后肝性脑病20例，术前肝功能Child-Pugh C级患者较A级、B级患者在术后3个月内更易出现肝性脑病。TIPS术后22例消化道出血，18例分流道失功能，26例病死。 结论： TIPS可有效降低门静脉压，合理选择患者可降低肝性脑病发生率，提高中远期疗效，为肝移植提供机会。.