Clinical Observation on Chinese Herbal Enema in Preventing and Treating Postoperative Hepatic Encephalopathy of TIPS for Cirrhosis-induced Portal Hypertension Accompanied by Upper Gastrointestinal Hemorrhage
Objective:To analyze the clinical effect of Chinese herbal enema after transurethral intrahepatic portosystemic shunt(TIPS)for cirrhosis-induced portal hypertension accompanied by upper gastrointestinal hemorrhage retrospectively.Methods:Collected data from 40 patients with portal hypertension caused by liver cirrhosis with upper gastrointestinal hemorrhage who underwent TIPS treatment from January 2012 to August 2017.Among them,20 patients were given routine treatment of acid suppression,anticoagulation,anti-infection and prophylactic anti-hepatic coma after TIPS and set as the control group;20 patients were given high position retention enema of Chinese medicine on the basis of the control group and set as the observation group;the course of treatment for both groups lasted for 7 day.Collected the blood ammonia(NH3)level before operation and 1 d,3 d,7 d after operation and liver functions of aspartate aminotransferase(AST),alanine transaminase(ALT),total bilirubin(TBil),albumin(Alb),prothrombin time(PT),and the hemodynamic parameters of veins(portal vein and splenic vein);4 to 156 weeks of follow-up after operation,recorded the incidence of recurrent hemorrhage and hepatic encephalopathy.Results:The success rate of operation of patients was 100%.The postoperative portal pressures in the two groups were significantly decreased when compared with those before operation(P<0.05);there was no significant difference being found between the two groups(P>0.05).There was no great change being found in the values of TBil in serum,Alb,ALT,AST and NH3 of patients in the control group before operation and 1 d,3 d,7d after operation(P>0.05).At 1 d and 3 d after operation,the Alb levels in serum in the observation group were significantly increased,compared with that before treatment and that in the control group at the same time point,differences being significant(P<0.05).At 3 and 7 d after operation,the values of NH3 in the observation group were significantly decreased,compared with that before treatment and that in the control group at the same time point,differences being significant(P<0.05).The blood vessel diameters of the portal and spleen veins were significantly decreased when compared with that before treatment on the 1 d,3 d,and 7 d after TIPS(P<0.05),and the blood flow velocity and blood flow of the portal and spleen veins were obviously increased when compared with that before treatment(P<0.05);there was no difference being found in the comparison of that at the same time points between groups(P>0.05).3 months and 3 to 12 months after operation:no hepatic encephalopathy occurred during the follow-up in the observation group,and the incidence of hepatic encephalopathy in the control group was 30.00%and 40.00%respectively,compared the two groups,differences being significant(P<0.05).No recurrent hemorrhage occurred in patients in the two groups within 3 months after operation.3 to 12 months after operation:there was no case of recurrent hemorrhage in the treatment group,and the recurrent hemorrhage rate was 30.0%in the control group,compared the two groups,differences being significant(P<0.05).Conclusion:The application of Chinese herbal enema after TIPS for cirrhosis-induced portal hypertension accompanied by upper gastrointestinal hemorrhage can effectively reduce blood ammonia levels,decline the incidence of hepatic encephalopathy and prevent mid and long term recurrent hemorrhage.It has a high clinical value.