Transjugular intrahepatic portosystemic shunt

Transjugular intrahepatic portosystemic shunt is used for surgical treatment of portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) is a new method for the treatment of portal hypertension in the 1990s. The method has the advantages of small trauma, high success rate, low complications, wide indications, significant reduction of portal pressure, and reliable treatment of esophageal varices bleeding. As one of the treatments for portal hypertension, TIPS is especially suitable for patients with advanced cirrhosis and plays an extremely important role in the treatment of portal hypertension. Treatment of diseases: portal hypertension Indication 1. Portal hypertension with esophageal varices bleeding is not effective after non-surgical treatment. 2. Prevention of esophageal varices rebleeding. 3. Rebleeding after devascularization. 4. Refractory ascites. 5. Budd-Chiari syndrome. 6. Preparative treatment before liver transplantation. 7. Preoperative preparation for devascularization. Contraindications 1. Severe liver damage. 2. The portal vein is narrow or obstructed. 3. Liver space-occupying lesions. 4. Organic heart disease. 5. Severe hepatic encephalopathy. Preoperative preparation 1. Liver function assessment Commonly used methods for assessing liver function are Child grading and Child-Pugh scoring criteria. Albumin, bilirubin, SGPT, PT and ascites are the main indicators of liver function assessment. Active hepatitis, severe liver damage, liver function score>11 were treated with TIPS with caution. 2. Ultrasound Doppler The test contents include liver, spleen size, ascites, portal vein and left and right branches, blood flow velocity and direction, blood flow, and special attention to the presence or absence of portal vein thrombosis and liver occupying lesions. Ultrasound Doppler detection of the portal vein system is to screen patients, study portal vein hemodynamic changes before and after surgery and early detection of stenosis or obstruction of intrahepatic shunt. 3. Selective superior mesenteric artery angiography Indirectly display the main stem and its branches, understand the anatomy of the portal system, collateral circulation, blood flow direction and reflux, further exclude portal vein thrombosis, and guide and position the hepatic vein to the portal vein. This check should be performed during the TIPS operation. 4. Magnetic resonance imaging (MRI) and electron beam CT angiography According to the distance between the hepatic vein and the intrahepatic branch of the portal vein displayed by magnetic resonance imaging and electron beam CT angiography, selecting the puncture point, puncture depth and angle of the hepatic vein to the portal vein branch helps to improve the success rate of portal vein puncture. Surgical procedure 1. TIPS operation is performed under the supervision of C-2000 DSA X-ray machine. 2. After the patient is supine, the head is biased to the left side, revealing the triangular region of the right neck, and 1% procaine injection is local anesthesia, puncture the internal jugular vein, and the guide wire is inserted after successful puncture, through the superior vena cava, right Atrium to the inferior vena cava. The Rups-100 catheter device was placed along the guidewire into the inferior vena cava and selectively into the right hepatic vein for contrast and pressure measurement. 3. Take the hepatic vein 2 to 3 cm from the inferior vena cava as the puncture point, adjust the direction of the guide forward, the puncture direction is the front lower, the puncture depth is about 3 to 4 cm, the puncture needle is withdrawn, the 5F catheter is pumped back, and the blood is drawn back. After the contrast agent is injected into the intrahepatic branch of the portal vein, the BENTSON soft head guide wire is placed through the portal vein to the splenic vein or superior mesenteric vein, and the 5F catheter is sent along the guide wire to the portal vein trunk, further confirming that the catheter enters the portal vein through the portal vein. The trunk, at this time, shows that the portal vein puncture is successful. 4. Using AMPLATZ super-strong guide wire to replace the BENTSON guide wire to send the portal vein and superior mesenteric vein, along the guide wire, the coaxial Rups-100 catheter device through the liver tissue to break through the portal vein branch to push the portal vein, respectively, portal vein angiography and pressure measurement , exit the 5F catheter, metal guide and catheter sheath, retaining the guiding sheath in the portal vein. 5. A balloon or dilatation tube with a diameter of 8 or 10 mm was placed along the guide wire to dilate the portal vein, liver parenchyma and hepatic vein respectively. The portal vein and hepatic vein waist-shaped impression disappeared and exited the balloon dilatation tube. The contrast agent was injected into the portal vein without spillage. After the internal support is placed, the portal vein is marked with the portal vein, and the expandable internal support is placed. The internal support should cover the entire intrahepatic shunt. The portal vein angiography shows that the portal vein blood flows through the shunt into the right atrium. 6. If esophageal varices are still shown, elective intubation to coronary vein embolization. 7. Perform portal vein and hepatic vein pressure measurement, remove the guide tube, retain the 5F catheter in the portal vein, and introduce the 5F catheter through the internal jugular vein. The sign of successful TIPS operation: 1 portal vein angiography showed portal vein blood flow through the intrahepatic portal shunt into the hepatic vein, inferior vena cava and right atrium; 2 coronary vein and esophageal varices disappeared; 3 portal pressure decreased by 12 ~ 15cmH2O, the door body Pressure gradient <12mmHg; 4 esophageal, gastric varices bleeding stopped. complication 1. Intra-abdominal bleeding. 2. Biliary bleeding. 3. Hepatic artery damage. 4. Acute pericardial tamponade. 5. The inner support is displaced or angled. 6. Hepatic encephalopathy. 7. Liver failure.