Knowledge about Transjugular Intrahepatic Portal Vein Stenting (TIPS) Shunt
Introduction to TIPS procedure.
TIPS is a minimally invasive procedure in which the transjugular route is punctured between the intrahepatic hepatic vein and the portal vein to create a portal shunt to reduce portal pressure and reduce or control bleeding from esophagogastric fundic varices, by which the portal pressure will be reduced. Symptoms caused by liver disease such as acute or subacute uncontrolled esophageal venous bleeding, ascites and pleural effusion that are difficult to control with medications can be improved.
Post-operative precautions for TIPS.
1.Usually, TIPS surgery is performed under local anesthesia, and the vital signs are routinely monitored for 6-12h after surgery.
2, postoperative jugular vein puncture site pressure bandage, the patient keep the head relatively fixed for 2-4h, pay attention to observe whether there is local blood leakage.
3.If transfemoral artery and percutaneous transhepatic puncture are performed during the operation, the same attention should be paid to observe whether there is bleeding at the puncture site.
4. Pay attention to the presence of abdominal pain, abdominal distension, dizziness, nausea, pallor, and changes in urine volume to prevent postoperative abdominal bleeding.
5, pay attention to observe the stool situation, including the color (mainly to understand whether there is black stool), the nature, whether there is constipation, etc.
6, pay attention to the observation of the changes in ascites, 1 week after surgery requires daily measurement of abdominal circumference, observe the volume of urine, whether there is a sudden change in more or less.
7, diet control: low protein gradual low plus diet.
8, postoperative prevention of constipation.
9, regular postoperative outpatient follow-up ultrasound, CT, gastroscopy and other examinations, the surgeon follow up!
Attachment: a case of cirrhosis and portal hypertension repeatedly performed esophagogastric fundic varices ligation patients, but still repeatedly vomiting blood in a classic case of TIPS treatment
Preoperative CT suggests that
Cirrhosis with coronary fundic varices
Significant coronary varices in the fundus of the stomach
Interventional portal vein puncture through the hepatic vein after imaging suggests varicose veins in the fundus with tortuous alignment!
After stent implantation, the portal blood flow smoothly shifted to the inferior vena cava through the hepatic vein-portal vein portal shunt channel, and the portal pressure decreased from 49cmH2O before surgery to 25cmH2O after surgery.
Post-operative CT showed good stent patency and significant atrophy of the fundic varices!
The patient has no shunt stenosis occlusion and no re-emission of blood so far at the outpatient follow-up!
Gastroscopic review showed that the esophagogastric fundic vein changed from severe varices before surgery to mild varices! The result is ideal!