title: [A comparison of efficacies between transjugular intrahepatic portosystemic shunt versus portoazygos devascularization in the treatment of portal hypertension with variceal bleeding].
abstract: OBJECTIVE
  To compare the efficacies between transjugular intrahepatic portosystemic shunt (TIPS) and portoazygos devascularization (PAD) in the treatment of portal hypertension with variceal bleeding.
  
  
  METHODS
  From December 1993 to December 2010, 309 patients with portal hypertension and variceal bleeding were admitted. According to their general conditions and Child-Pugh grades, they were assigned to undergo TIPS (group A, n = 235) or PAD (group B, n = 74). Before operation, compared with the PAD group, the TIPS group possessed worse liver functions, more severe ascites and a greater frequency of bleeding. After operation, the therapeutic efficacies and changes of portal hemodynamics, recurrent variceal bleeding, post-operative encephalopathy and long-term survival were evaluated between two groups.
  
  
  RESULTS
  The postoperative portal pressure in the TIPS group ((42.6 ± 7.0) vs (26.3 ± 4.1) cm H2O) decreased much more than that in the PAD group ((38.7 ± 5.2) vs (33.5 ± 5.8) cm H2O, P < 0.01). The rebleeding rates during early postoperation were 0.85% (2/235) and 6.76% (5/74) in TIPS and PAD groups respectively, the occurring rates of hepatic encephalopathy 4.68% (11/235) and 4.05% (3/74) and the rates of operative mortality 1.70% (4/235) and 6.76% (5/74) respectively. Survival rates of 1, 3, 5 and 10 years were 98.30% (231/235) vs 92.24% (69/74), 92.41% (146/158) vs 88.06% (59/67), 80.77% (84/104) vs 79.25% (42/53), 51.43% (36/79) vs 51.85% (14/27) in TIPS and PAD groups respectively.
  
  
  CONCLUSIONS
  As compared with PAD, TIPS offers the such advantages as less trauma, wider indication, faster hemostasis and satisfactory therapeutic efficacies. Especially for the emergency treatment of a patient with massive variceal bleeding and Child-Pugh C grade liver function, TIPS is a better option than PAD.
authors.affiliation: Department of Hepatobiliary Surgery, Airforce General Hospital, People's Liberation Army, Beijing , China. x_xb008@sina.com
authors.forename: Xin-bao
authors.initials: XB
authors.lastname: Xu
authors.forename: Jian-guo
authors.initials: JG
authors.lastname: Chu
authors.forename: He
authors.initials: H
authors.lastname: Huang
authors.forename: Hong-yi
authors.initials: HY
authors.lastname: Zhang
authors.forename: Hong-yi
authors.initials: HY
authors.lastname: Zhang
authors.forename: Cheng-li
authors.initials: CL
authors.lastname: Liu
authors.forename: Mei
authors.initials: M
authors.lastname: Xiao
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.forename: Zhi-qiang
authors.initials: ZQ
authors.lastname: Feng
authors.forename: Gang
authors.initials: G
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001401:Azygos Vein / Q000601:surgery; D002648:Child; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult