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The results of applying Transjugular intrahepatic portosystemic shunt in the treatment of recurrent portal genesisbleeding

Author: 
Shavkat Ibragimovich Karimov and Matkuliev Utkirbek Ismailovich
Subject Area: 
Health Sciences
Abstract: 

Background: One of the most significant developments in recent years relating to the treatment of bleeding varicose veins of the esophagus and stomach (VVES) at Portal hypertension (PH), is the introduction into practice of the new endovascular technique - transjugular intrahepatic porto-systemic shunt (TIPS). TIPS is minimally invasive method of creating a portosystemic shunt to decompress the portal venous system and method allows embolize tributaries (left gastric vein, short gastric vein) VVES and thereby reduce the risk of bleeding. Aim: To study evaluation efficacy of the treatment of patients after TIPS with recurrent bleeding from VVES when endoscopic intervention were unsuccessful. Materials and Methods: Analyzed the results of examination and treatment of 76 patients undergoing TIPS attempt was made. 18 patients were in the Department of Abdominal Surgery of 2ndClinic of Tashkent Medical Academy (2014-2015), 58 - in the Chonnam National University Hospital (Republic of Korea) (2003-2013). In the 65 observations TIPS was successful. In 11 patients, due to technical difficulties (repeated exploratory puncture of the portal vein), TIPS failed. Of these, 8 patients had PH decompensated with refractory ascites. The technical success of the TIPS was 85.5%. Results: In 58 patients underwent TIPS observations using bare metal stents and 7 cases -stent grafts. In all cases there was a reduction of the pressure gradient, with an average of 21,1 ± 4,5 to 11,5 ± 1,8 mm Hg. Worsening encephalopathy was observed in 15 patients (23.0%). In 5 cases, the progression of liver failure was observed. Mortality from progressing PN observed in 2 patients. In 48 cases, TIPS was performed to stop the bleeding when the endoscopic procedures were unsuccessful. Hemostasis by reducing portal pressure was 95.8% (46 cases). In 2 cases of bleeding after TIPS marked relapse in the early period of shunt thrombosis. Patients were subjected to endovascular recanalization shunt. In 5 (8.0%) patients revealed thrombosis of intrahepatic stent and in 57 (89.2%) - portosystemic shunts were passable. Recurrent bleeding from VVES noted in 3 (4.8%) patients, which was the cause of death in one case. The growth of ascites was observed in 1 (1.6%) patients. Conclusion: We concluded that the main method of stop recurrent bleeding from VVES in patients with portal hypertension is TIPS. High mortality after implementation of public emergency operations at an altitude of bleeding stresses the need for the introduction of TIPS in the minutes introducing patients to emergency surgery. Moreover, TIPS is a type of porto-systemic shunt and cannot be considered a definitive treatment for patients with liver cirrhosis complicated with portal hypertension.

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