[Comparison of the curative effect of transjugular intrahepatic portosystemic shunt with expanded polytetrafluoroethylene-covered stent and drug combined with gastroscopy as the secondary prevention of esophageal -gastric variceal bleeding in portal hypertension].

Objective: To compare the clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS) with expanded polytetrafluoroethylene (ePTFE)-covered stent and drug combined with gastroscopy as the secondary prevention of esophageal-gastric variceal bleeding in portal hypertension. Methods: Patients with esophageal-gastric variceal bleeding who received TIPS treatment (ePTFE covered stent) or gastroscopy for the first time as the secondary prevention for portal hypertension at Nanfang Hospital of Southern Medical University through March to July 2017 were selected. One year after the operation, liver function changes, ascites remission rates, incidence of hepatic encephalopathy, re-bleeding rate, average hospitalization frequency and expenses, survival time, as well as the TIPS patency conditions were analyzed in the two groups of patients. 2 test, Kaplan-Meier method and Mann-Whitney U test were used to analyze the data. Results: There were 74 and 66 cases in the TIPS and the drug combined gastroscopy group and the follow-up duration (14.57 ± 0.79) was 12-16 months. One year after surgery, the remission rate of ascites in the TIPS group was higher 57.1% (32/56) than that of the drug combined gastroscopy group (0), and the difference was statistically significant (χ(2) = 2 = 36.73, P < 0.01). The cumulative incidence of hepatic encephalopathy at 1, 3, 6, and 12 months after surgery in the TIPS group was 32.4% (24/74), 37.8% (28/74), 40.5% (30/74), and 40.5% (30/74), respectively. The cumulative incidence of hepatic encephalopathy in the drug combined gastroscopy group was 3.0% (2/66), 3.0% (2/66), 3.0% (2/66), and 6.1% (4/66), respectively. Kaplan-Meier analysis showed that the cumulative incidence of hepatic encephalopathy in the TIPS group was higher than that of the drug combined gastroscopy group (χ(2) = 11.29, P < 0.01). The incidence of severe hepatic encephalopathy ( grade III to IV) at 1, 3, 6, and 12 months after surgery in the TIPS group was 2.7% (2/74), 0, 0, and 0, respectively. The incidence of severe hepatic encephalopathy in drug combined gastroscopy group was 0, and there was no statistically significant difference in development of hepatic encephalopathy between the two groups (P > 0.05). The re-bleeding rates of TIPS group and drug combined gastroscopy group were 0 and 27.3% (18/66), respectively, and the difference was statistically significant (χ(2) = 22.42, P < 0.01). There was no death reported during the follow-up period between both groups. The hospitalization frequency times (1.45 ± 0.80) in TIPS group was lower than that of the drug combined gastroscopy group times (3.24 ± 1.80), and the difference was statistically significant (U = -4.52, P < 0.01). Conclusion: In the prevention of esophageal-gastric variceal bleeding, TIPS (ePTFE-covered stent) treatment has the advantages of reducing re-bleeding rate, high ascites remission rate and hospitalizations frequency. In addition, patients treated with TIPS have a higher incidence of hepatic encephalopathy than that of drugs combined with gastroscopy. However, TIPS did not exacerbate the incidence of hepatic encephalopathy, and there was no significant difference in the 1-year survival rate after TIPS and drugs combined with gastroscopy treatment.

[Ethanol for hepatic arterial embolization (experimental study)].

In this experiment, 27 dogs underwent hepatic arterial embolization (HAE) with 99% ethanol in 10 (group A), 75% ethanol in 10 (group B) and 60% ethanol in 7 (group C). By the laparotomy, catheter was inserted into hepatic artery and ethanol at dose of 0.3 ml/kg was injected within 20 seconds. Arterial angiography was taken before and after HAE. The dogs were sacrificed in 1, 2, 4, 8 weeks. Liver specimens were examined grossly and microscopically. Both A and B group showed satisfactory results of embolization, but 99% ethanol caused severe damage to hepatocytes, perisinusoidal area and bile ducts. Eight of 10 dogs died of hepatic failure and infection within two weeks. 75% ethanol mainly occluded the smaller arterial branches. Hepatocellular and biliary tract lesions were slight and reversible. All the animals survived normally except two. Group C had some mild and limited liver damage and scattering thrombosis which might result from intima lesion. This article also discusses the clinical availability of ethanol HAE.

[Iatrogenic hemobilia: clinical manifestation, diagnosis and management].

In the last 4 years, we had 8 cases of iatrogenic massive bleeding from the biliary duct following operations on the liver and bile ducts. It seemed to us that it was not an infrequent complication. In this communication, the clinical manifestations, diagnosis and management of the complications were presented with special emphasis on the importance of angiography in the diagnosis of this condition. In this series, 6 cases were treated successfully by trans-catheter embolization. It is believed that embolization is safe, reliable, and should be the procedure of choice in the treatment of this complication.