Liver cirrhosis is one of the most important public health issues in China. The etiological treatment for patients with decompensated liver cirrhosis to delay progression has always been the practical and effective classical strategy. High- quality or creative methods for diagnosis and treatment come from ordinary and careful work. Portal hypertension is in nature a vascular disease,and relief of pressure in the portal system in time is the key to prevention of disease progression and various severe complications. The therapeutic decision should be made on the basis of a comprehensive understanding of portal hypertension,and minimally invasive techniques are important methods for such strategies.

In recent years,with the development in basic research and clinical application,the success rate of transjugular intrahepatic portosystemic shunt( TIPS) has been increased significantly,and stent restenosis rate and the incidence of postoperative hepatic encephalopathy have been controlled. With reference to the authors' clinical practice and hot topics of conferences at home and abroad,this article introduces the advances in TIPS- related techniques and their application in liver cirrhosis,including TIPS puncture technique,TIPS stent,TIPS- related hepatic encephalopathy and its prevention and treatment,TIPS indications and contraindications,the issues solved by TIPS in liver cirrhosis,and the advantages and disadvantages of TIPS in the treatment of esophagogastric variceal bleeding compared with other therapeutic methods,in order to make contributions to the development of TIPS and bring more benefits to patients with liver cirrhosis.

Objective To investigate the effect of antiviral therapy on the prognosis of patients with decompensated hepatitis B cirrhosis who underwent transjugular intrahepatic portosystemic shunt( TIPS). Methods The clinical data of 110 patients with decompensated hepatitis B cirrhosis who underwent TIPS to prevent variceal rebleeding from January 2008 to December 2011 were analyzed retrospectively,and based on whether they used antiviral drugs or not,these patients were divided into TIPS- antiviral drug group( 58 patients) and TIPS group( 52patients). The t- test or Wilcoxon rank sum test was applied for comparison of continuous data between the two groups,and the chi- square test was applied for comparison of categorical data between the two groups. The Kaplan- Meier survival analysis and log- rank test were performed to analyze the cumulative survival rate,rebleeding rate,stent patency rate,and incidence of hepatocellular carcinoma( HCC). Results The 1-,3-,and 5- year cumulative survival rates after TIPS in the TIPS- antiviral drug group versus the TIPS group were 93. 1%vs 88. 5%,86. 1% vs 64. 9%,and 77. 7% vs 59. 7%,respectively,and the TIPS- antiviral drug group had a significantly higher cumulative survival rate than the TIPS group( χ2= 6. 833,P = 0. 009). In the TIPS- antiviral drug group,the virologic response rate increased with the prolonged time of antiviral therapy. The cumulative variceal rebleeding rate,stent patency rate,and incidence of HCC showed no significant differences between the two groups( all P > 0. 05). Conclusion Antiviral therapy can improve the survival rate of patients with decompensated hepatitis B cirrhosis after TIPS.

Objective To investigate the short- term effect and safety of transjugular intrahepatic portosystemic shunt( TIPS) in the treatment of decompensated primary biliary cirrhosis( PBC). Methods The clinical data of 26 patients with decompensated PBC who received TIPS in Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2009 to May 2015 were analyzed retrospectively.The indicators including portal venous pressure,liver function,and survival before and after TIPS during 1 year of follow up were compared.The Friedman test was applied as the rank sum test for multiple related samples,the Wilcoxon test was applied as the paired rank sum test,and the Kaplan- Meier curve was applied for survival analysis. Results All patients had significantly reduced mean portal pressure after TIPS( 1911( 16. 35- 22. 05) mm Hg vs 27. 93( 25. 26- 30. 87) mm Hg; Z =- 4. 199,P < 0. 001). Within 3 months after TIPS,the patients showed significant increases in total bilirubin,Model for End- Stage Liver Disease score,and bile acid( χ2= 26. 000,18. 429,and16. 353,all P < 0. 001). The most common postoperative complication was pyrexia,which had an incidence rate of 80. 77%( 21 /26),followed by hepatic encephalopathy,with an incidence rate of 19. 23%( 7 /26). The survival rates at 6 and 12 months after surgery were both92. 3%( 24 /26). Conclusions TIPS has good short- to medium- term effect and safety in the treatment of decompensated PBC,and its long- term effect still needs to be proved.

Objective To compare the effects of transjugular intrahepatic portosystemic shunt( TIPS),percutaneous transhepatic variceal embolization( PTVE),and TIPS combined with gastric coronary vein embolization( GCVE) in patients with cirrhotic portal hypertension complicated by upper gastrointestinal bleeding. Methods A total of 167 patients with cirrhotic portal hypertension complicated by upper gastrointestinal bleeding who underwent surgical treatment in Tongchuan Mining Bureau Central Hospital from January 2012 to October 2014 were analyzed retrospectively and divided into TIPS group( 56 patients),PTVE group( 53 patients),and TIPS- GCVE group( 58 patients) according to the difference in surgical method. The time of operation,time to postoperative recovery,hospital costs,postoperative improvement in gastrointestinal varices,incidence of rebleeding,incidence of hepatic encephalopathy,ascites elimination rate,indices related to the portal vein( diameter of the portal vein,portal vein velocity,portal venous pressure),and liver function parameters( ALT,AST,TBil,and Alb) were compared between the three groups. Comparison of continuous data between these groups was made by analysis of variance,and pairwise comparison was made by SNK- q test; comparison of categorical data between these groups was made by chis- quare test.Results There were significant differences in the time of operation,hospital costs,incidence of postoperative rebleeding,and incidence of postoperative hepatic encephalopathy between the three groups( F = 13. 85 and 12. 53,respectively,χ2= 7. 132 and 6. 368,respectively,all P < 0. 05). The hospital costs showed a significant difference between the TIPS group and the PTVE group( q = 2. 84,P < 0. 05); there were significant differences in the time of operation,hospital costs,incidence of postoperative rebleeding,and incidence of postoperative hepatic encephalopathy between the TIPS group and the TIPS- GCVE group( q = 3. 99 and 2. 58,respectively,χ2= 7. 396 and 6. 183,respectively,all P < 0. 05); there were significant differences in the time of operation,hospital costs,incidence of postoperative rebleeding,and incidence of postoperative hepatic encephalopathy between the PTVE group and the TIPS- GCVE group( q = 4. 53 and 3. 99,respectively,χ2=7. 534 and 5. 461,respectively,all P < 0. 05). Conclusion Although TIPS- GCVE has longer time of operation and higher hospital costs than TIPS and PTVE,it can significantly reduce the incidence of postoperative rebleeding and hepatic encephalopathy.

Objective To investigate the association between serum ascites albumin gradient( SAAG) and esophagogastric variceal bleeding in patients with liver cirrhosis. Methods The databases Pub Med,Embase,the Cochrane Library,Wanfang Data,VIP,and CNKI were searched to obtain Chinese articles on SAAG and esophagogastric variceal bleeding in patients with liver cirrhosis published between January 2001 and June 2015,and each article should include a bleeding group and a non- bleeding group. Strengthening the reporting of observational studies in epidemiology( STROBE) was used as a reference to evaluate the quality of articles. The mean ± standard deviation( SD) of SAAG in bleeding groups and non- bleeding groups were pooled and analyzed. The Meta- Analyst software was used to calculate standardized mean differences( SMD) of SAAG between bleeding groups and non- bleeding groups and perform the meta- analysis. The chi- square test was applied for comparison of categorical data between groups. Results Thirteen articles met the inclusion criteria. SAAG was( 22. 54 ± 4. 69) g / L in bleeding groups and( 15. 91 ± 4. 20) g / L in non- bleeding groups. The test for heterogeneity showed significant heterogeneity( Q = 100. 735,I2=89. 065,P < 0. 001),and the bleeding groups had a significantly higher SAAG than the non- bleeding groups( SMD = 1. 970,95% CI: 1. 425- 2. 515,P < 0. 001). According to the SAAG level,the patients were divided into the group with a SAAG of < 15 g / L,the group with a SAAG of ≥15 g / L and ≤19. 9 g / L,and the group with a SAAG of ≥20 g / L,and with the increasing SAAG,the proportion of patients experiencing variceal bleeding increased significantly( χ2= 111. 702,P < 0. 001). Conclusions SAAG is closely associated with esophagogastric variceal bleeding in patients with liver cirrhosis,and the bleeding groups have a higher SAAG than the non- bleeding groups. SAAG may be applied as a valuable indicator to predict esophagogastric variceal bleeding in patients with liver cirrhosis.

Objective To investigate the clinical manifestations of portal vein thrombosis( PVT) and related risk factors in patients with liver cirrhosis. Methods A total of 541 patients with liver cirrhosis who were admitted to the General Hospital of Ningxia Medical University from April 2008 to April 2015 were included in the study; 76 patients with PVT were enrolled in the study group,and another 76 patients without PVT matched for sex,age,and Child- Pugh class were enrolled in the control group. The clinical data and related indicators were analyzed and compared between the two groups. The t- test was applied for comparison of continuous data between groups,the chi- square test was applied for comparison of categorical data between groups,and the unconditional logistic regression model was used to determine the independent risk factors for PVT in liver cirrhosis. Results In the patients with liver cirrhosis and PVT,42. 1%( 32 /76) had an insidious onset and 57. 9%( 44 /76) had obvious clinical manifestations. Most patients had Child- Pugh class B and C cirrhosis. There were significant differences between the two groups in platelet count,blood glucose,percentage of neutrophils,severe esophageal and gastric varices,plasma D- dimer,portal vein width,and thickness of the spleen( all P < 0. 05). The unconditional logistic regression model analysis showed that percentage of neutrophils( OR = 1. 044,P = 0. 040),plasma D- dimer( OR = 0. 091,P = 0. 000),portal vein width( OR =0. 030,P = 0. 008),and thickness of the spleen( OR = 0. 427,P = 0. 003) were the influencing factors for PVT. Conclusion PVT may have an insidious onset in patients with liver cirrhosis,or have different clinical manifestations. Cirrhotic PVT usually occurs in patients with advanced liver cirrhosis,and plasma D- dimer,portal vein width,thickness of the spleen,and percentage of neutrophils are the independent influencing factors for PVT in patients with liver cirrhosis.

Objective To observe the effect of continuous blood purification( CBP) on serum inflammatory mediators in patients with severe acute pancreatitis( SAP) and multiple organ dysfunction syndrome( MODS). Methods Sixty- five SAP patients with MODS who were treated in General Hospital of Chengdu Command Area of Chinese PLA from April 2008 to December 2013 were enrolled and divided into two groups. The 33 patients in the control group received comprehensive internal medicine treatment,and the 32 patients in the treatment group received comprehensive internal medicine treatment and CBP. Changes in APACHE II score,MODS score,and the serum levels of tumor necrosis factor α( TNFα),C- reactive protein( CRP),interleukin 6( IL- 6),IL- 18,platelet- activating factor( PAF),and nitric oxide( NO) after treatment were observed. Independent- samples t test was applied for comparison of continuous data between the two groups,and paired t test was applied for before- after comparison within the same group; chi- squared test was applied for comparison of categorical data between the two groups. Results In both groups,APACHE II score,MODS score,and the serum levels of TNFα,CRP,IL- 6,IL- 18,PAF,and NO decreased significantly after treatment( all P < 0. 05),and the treatment group had significantly greater decreases in these values than the control group( all P < 0. 001); the survival rates in the treatment group and the control group were 90. 6%( 29 /32)and 78. 8%( 26 /33),respectively,with no significant difference between the two groups( χ2= 1. 749,P = 0. 186). Conclusion In SAP patients with MODS,CBP can effectively clear the serum inflammatory mediators to block systemic inflammatory response and improve organ function,and,therefore,it is an effective method to treat SAP.

Objective To investigate the clinical effect of plasma exchange( PE) combined with hemofiltration( HF) in the treatment of subacute liver failure( SALF) induced by antitubercular agents. Methods A total of 58 patients with SALF induced by antitubercular agents who visited Henan Provincial People's Hospital from July 2009 to January 2015 were collected and divided into PE treatment group( 27patients) and PE- HF combined treatment group( 31 patients) according to different therapeutic methods. The changes in clinical symptoms and signs,liver function,renal function,electrolytes,and coagulation function after treatment were investigated and compared between the two groups,and the incidence of adverse events and 6- month survival rate were observed in both groups. The t- test was applied for comparison of continuous data between groups,and the chi- square test was applied for comparison of categorical data between groups. Results After treatment,both PE treatment group and PE- HF combined treatment group had significant reductions in the levels of ALT,AST,TBil,GGT,and ALP,as well as a significant increase in prothrombin activity( PTA)( t = 2. 871,2. 986,2. 905,2. 063,4. 028,- 2. 591,2. 940,2. 935,2. 940,2. 918,4. 981,and- 2. 933,all P < 0. 05); the PE- HF combined treatment group had significantly greater reductions in ALT,AST,TBil,GGT,and ALP and a significantly greater increase in PTA,as compared with the PE treatment group( t =- 2. 891,-2. 784,- 2. 194,- 3. 014,- 0. 294,and- 3. 907,all P < 0. 05). In the PE treatment group,the response rates to correct high urea( UREA),high creatinine( Cr),hypokalemia,hyponatremia,hypochloridemia,and hypocalcemia were 80. 00%,60. 00%,81. 82%,78. 57%,88. 89%,and 75. 00%,respectively; in the PE- HF combined treatment group,these response rates were 85. 71%,87. 50%,85. 71%,92. 31%,92. 31%,and 86. 67%,respectively; there were significant differences in these response rates between the two groups( χ2= 9. 603,11. 302,9. 543,13. 987,9. 493,and 9. 502,all P < 0. 05). The PE treatment group had an overall response rate of88. 89% and a mean hospital stay of 36. 36 days,while the PE- HF combined treatment group had an overall response rate of 96. 77% and a mean hospital stay of 26. 03 days; the incidence rates of adverse events in these two groups were 5. 06% and 7. 06%,respectively. Conclusion As for the treatment of SALF induced by antitubercular agents,compared with PE treatment alone,PE combined with HF can significantly relieve patients' clinical symptoms and signs,improve liver function,correct electrolyte disturbance,improve renal function,increase overall response rate,and reduce the mean hospital stay,and has a lower incidence rate of adverse events. Therefore,it is an effective and safe therapeutic method.

Transjugular intrahepatic portosystemic shunt( TIPS) can effectively reduce portal hypertension,prevent recurrent esophagogastric variceal bleeding,and relieve intractable ascites. TIPS involves vessel puncture,expansion of puncture tract within the liver parenchyma,and stent implantation,and may cause various complications. The effective prevention and treatment of TIPS- related complications have become a new direction for research in TIPS. This article reviews the intraoperative and postoperative complications of TIPS and related preventive and treatment strategies.