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Objective To evaluate transjugular intrahepatic portosystemic stent shunt (TIPSS) together with embolization of gastric varicosity in the treatment of cirrhotic portal hypertension and digestive tract bleeding.
Materials and Methods TIPSS plus embolization of gastric varicosity was performed in 81 patients (61 males and 20 females, aged 32~74 years) with cirrhotic portal hypertension and digestive tract bleeding. All patients experienced 1~3 episodes of digestive tract bleeding. Hypersplenism was accompanied in 58 cases, and ascites in 30 cases. Afterthe puncture of the portal veinwas accomplished, splenic venography was carried out to identify the varicosity of the gastric coronary and short veins. A 5F Cobra catheter was super-selectively catheterized into gastric coronary vein, 5% sodium morrhuate was injected via the catheter to embolize the varicosity, additional spring coil was used to strengthen the embolization in cases with larger varicose veins. Gastric short vein was embolized too if it participated in the developing of varicosity. Then, TIPSSwas established. Sixty-four patients receivingTIPSS onlywere selected as
control group.
Results The procedure was successful in all 81 patients. The bleeding was immediately stopped and no serious complications occurred. During a following-up period of 1~12 months, 51 patients underwent GI exam, showing a marked relief of esophageal and gastric varicosity. Stenosis of the shunt stent with small amount digestive tract bleeding occurred in 7 patients (8.6%) within 10 months after the surgery. Reoccurrence of digestive tract bleeding in the control group was seen in 10 cases (15.6%).
Conclusion TIPSS with embolization of gastric varicosity can effectively stop digestive tract bleeding and, thus, is the most reasonable interventional method for the treatment of cirrhotic portal hypertension and digestive tract bleeding.
【Key words】 Portal hypertension Cirrhosis Gastric coronary vein TIPSS Embolization
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