Chinese Journal of Clinicians, Vol 6, No 7 (2012)

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Improved TIPS therapy by percutaneous portal vein puncture portography in 23 patients of portal hypertension with acute upper gastrointestinal bleeding

ZHANG Hong-yi, FENG Zhi-qiang, LI Li, WU Di, PIAO Long-song, LI Zhi-jie, HE Xiao-jun, ZHANG Hui, XU Xin-bao, XIAO Mei, ZHANG Hong-yi


  Objective To study clinical efficacy of improved TIPS by percutaneous portal vein puncture for enhancing its accuracy and safety.Methods 23 cases of portal hypertension with acute upper gastrointestinal bleeding reformed percutaneous portal vein puncture improved TIPS from 2010 to 2011 at Air Force General Hospital of Chinese PLA were investigated retrospectively.The right portal branch was punctured under ultrasonic guidance.Then the Cobra catheter was put into the portal vein for portography,the gastric coronal vein was embolized and portal pressure was measured.The Cobra catheter was detained in the portal vein for portography of anterior and lateral position.The Rups-100 was guided under the Cobra catheter during the TIPS puncture procedure.The balloon was used to dilate the parenchyma channel and then the metal stent was released smoothly.To ensure the effectiveness,portography was made and portal pressure was measured again.Results All cases reformed portal vein puncture improved TIPS successfully,acute upper gastrointestinal bleedings were controlled immediately.Operative time was(140.32±43.56)min,time from the beginning of operation to gastric coronary vein occlusion was(12.53±13.18)min,the number of puncture was 4.16±2.73.TIPS can reduce portal pressure significantly.No significant difference was observed in blood ammonia before and after TIPS.Conclusions Ultrasound-guided percutaneous portal vein puncture angiography can guide TIPS operation,control gastric coronary vein bleeding at once,and improve the accuracy and safety of TIPS.

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Chinese Journal of Clinicians