For patients with upper gastrointestinal hemorrhage, we have opened a green treatment channel, and the following three patients have been treated recently, all of whom were successfully treated.
Case 1, female, 63 years old, was admitted to the hospital in an emergency because of “repeatedly relieving blood and tarry stools for 3 months and vomiting a lot of blood for 7 hours”. The patient had suffered from hepatitis B for more than 40 years and was severely anemic at the time of admission, with hematocrit 65g/L, poor liver function and poor coagulation function. The patient was diagnosed with cirrhosis, portal hypertension and ruptured esophagogastric fundic variceal bleeding, and his condition was too poor to tolerate open surgery. Minimally invasive surgery was performed, namely transjugular intrahepatic portosystemic shunt (TIPS) and gastric coronary vein embolization, which involves puncturing two very small needle-eye channels through the root of the right thigh (right inguinal region) and one needle-eye channel through the right side of the neck, combining the upper and lower parts of the bleeding portal vein to divert the blood flow to the inferior vena cava and seal the gastric coronary vein causing the bleeding, during the treatment The patient was always awake, without anesthesia, and was given only a small amount of analgesic medication. The patient was in no significant pain and was able to tolerate the treatment better, and postoperative hemostasis with pressure from 3 small needle eyes was sufficient, and there was no surgical incision. The patient’s bleeding stopped after surgery, ascites disappeared, and he was discharged from the hospital, and his condition is now stable. Xu Xinbao, Department of Hepatobiliary Surgery, Air Force General Hospital
Case 2, male, 58 years old, was admitted to the hospital in emergency with “intermittent vomiting of blood and blood in stool for 4 years and massive vomiting of blood for 5 hours”. The patient had viral hepatitis B since he was 5 years old and was found to have cirrhosis for many years, anemia, ascites, and liver function Child C. He was not suitable for open surgery. He was given a transjugular intrahepatic portosystemic shunt (TIPS) and gastric coronary vein embolization, after which the bleeding stopped and the ascites disappeared, and was discharged in good condition.
Case 3, male, 49 years old, was admitted with “cirrhosis of the liver for 16 years, recurrent vomiting of blood and blood in the stool for 40 days”, with no history of hepatitis, but “Buga’s syndrome” for many years. The patient was diagnosed as: ruptured esophagogastric fundic variceal bleeding; portal hypertension; liver cirrhosis; and Buga’s syndrome. After treatment and consultation at several hospitals in Beijing, all of them were considered inoperable and not suitable for minimally invasive treatment. After admission to our hospital, an internal jugular vein intrahepatic portal shunt (TIPS) and inferior vena cava stent implantation were performed after examination and evaluation. The procedure was successful, and the patient’s bleeding stopped and he was discharged in good condition.
The following two pictures were taken during the TIPS treatment: the top picture shows the curved mesh stent after the intrahepatic shunt stent implantation; the bottom picture shows the smooth blood flow in the stent (the stent is filled with black contrast and flows to the inferior vena cava and atrium), which shows the successful shunt.