Kết quả 4 năm thực hiện kỹ thuật tạo shunt cửa - chủ trong gan qua tĩnh mạch cảnh tại Bệnh viện Trung ương Quân đội 108

Objective: To evaluate efficacy of TIPS therapy in controling recurrent haemorrhage due to gastro-oesophagieal variceal rupture in portal hypertensive cirrhotic patients. Suject and method. From September 2009 to June 2013, 65 patients with portal hypertensive cirrhotic liver disease complicated by recurrent variceal bleeding were treated with TIPS therapy. During TIPS procedure, the authors evaluated pre and post operative portal pressure, porto-systemic pressure gradient and complications. Clinical and endoscopic follow up gave information of re-bleeding control and hepatic encephalopathy syndrome. Result. TIPS placement was successful in 98.5 percent of cases. There was a reduction of mean portal presure from 32.6 +/- 5.7mmHg before treatment to 22.7 +/- 5.7mmHg after intervention, and a reduction of mean porto-systemic gradient from 20.0 +/- 4.9 mmHg to 5.3 +/- 3.5 mmHg. The rate of gastro-oesophagieal variceal re-bleeding was 25 percent, hepatic encephalopathy syndrome was 35.9 percent, occlusion and restennosis shunt was 37.5 percent. Mortality rate after TIPS was 20.3 percent. The most severe complication was intra-abdominal bleeding, accounted for 1.5 percent. Other complications were mild and resolved spontaneously. Conclusion. TIPS is an effective treatment resulting in reduction of portal hypertention and control of recurrent bleeding from variceal rupture in portal hypertensive cirrhotic liver patients. However, hepatic encephalopathy is a severe complication that need to be well prevented and repaired.