Clinical effect of ultrasound-guided portal vein puncture guided transjugular intrahepatic portosystemic shunt combined with varicose vein embolization in the treatment of esophageal gastric fundus varices rupture and bleeding
LIN Gang-yi MA Ming-yuan CAI Zong-yang
Department of Vascular Intervention, Shantou Central Hospital of Guangdong Province, Shantou 515031, China
Abstract：Objective To explore the clinical effect of ultrasound-guided portal vein puncture guided transjugular intrahepatic portosystemic shunt (TIPS) combined with varicose vein embolization in the treatment of esophageal and gastric fundus varices rupture and bleeding. Methods Sixty patients with esophageal gastric fundus rupture and bleeding who were treated in our hospital from December 2015 to January 2018 were selected as the research subjects, they were divided into observation group (n=30) and control group (n=30) by random number table method. The control group was treated with traditional TIPS pathway combined with percutaneous transhepatic variceal embolization (PTVE),the observation group was treated with ultrasound guided portal vein puncture guided TIPS combined with varicose vein embolization. Surgical indicators, liver vascular conditions, and liver function indexes before and after treatment were compared between the two groups. Results The number of shunt punctures in the observation group was less than that in the control group, the length of the shunt puncture and surgery was shorter than that of the control group, the success rate of shunt punctures was higher than that of the control group, the differences were statistically significant (P＜0.05). The portal vein diameter, splenic vein diameter and hepatic artery flow velocity in the observation group were lower than those in the control group, the portal vein velocity, splenic vein flow velocity and hepatic artery vascular resistance index (RI) were higher than those in the control group, the differences were statistically significant (P＜0.05).The albumin level in the observation group after treatment was higher than that in the control group, the levels of total bilirubin and alanine aminotransferase were lower than those in the control group, the differences were statistically significant (P＜0.05). Conclusion Ultrasound-guided portal puncture-guided TIPS combined with varicose vein embolization for esophageal gastric fundus varicose rupture and bleeding can reduce the number of shunt punctures, shorten the shunt puncture time and the length of surgery, improve the success rate of shunt punctures, and improve the patients′liver and blood vessels and liver function indicators.
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