Abstract: Objective To evaluate the mid-long-term clinical efficacy of transjugular intrahepatic portosystemic shunt （TIPS）combined with gastric coronary vein em bolization（GCVE）for portal hypertension complicated with upper gastrointestinal bleeding. Methods Ninety-nine cirrhosis patients,w ho had received TIPSfor upper gastrointestinal hem orrhage due to portal hypertension fro MJanuary 2008 to January 2013 in the second affiliated hospital of Kun ming Medical University,were retrospectively analyzed. AMong these patients,43 received TIPS（TIPSgroup）and 56 received TIPSplus GCVE（TIPS+GCVEgroup）.Portal venous pressure（PVP）and portal pressure gradient（PPG）of both groups before and after treatment were compared by Ttest. Upper gastrointestinal rebleeding rate,survival rate and stent patencybook=18,ebook=22rate in both groups during a follow-up were analyzed by Kaplan-Meier method,which was further compared by log-rank test between the two groups. Results Preoperative PVPin TIPSgroup and TIPS+GCVEgroup were（35.2±3.1）,（35.3± 3.6）MMHg（1 MMHg=0.133 kPa）,w hile postoperative PVPwere（21.9±2.8）,（22.7±3.1）MMHg;preoperative PPGin two groups were（25.8±3.2）,（25.5±2.3）MMHg,w hile postoperative PPGwere（11.6±1.7）,（12.8±1.5）MMHG. Postoperative PVPand PPGwere lower than preoperative ones in both groups,which showed statistically significant differences（TIPSgroup：t=15.772、15.722,P=0.000;TIPS+GCVEgroup：t=31.069、31.096,P=0.000,respectively）. However,there was no significant difference in PVPbefore and after treatment between two groups. Between the two groups,preoperative PPGshowed no significant difference,while postoperative PPGin TIPS+GCVEgroup was statistically significantly higher than thatin TIPSgroup（t=-4.726,P=0.000）. A1l cases were followed up for 1 to 54 Months after operation with an average of（36.3±11.1）Months. The free of variceal rebleeding rates in 6 Months,12 Months,24 Months and 48 Months after operation were 90.7％,86.0％,76.7％and 65.1％in TIPSgroup,respectively,and 98.2％,92.6％,89.3％and 85.7％in TIPS+GCVEgroup,respectively,which revealed statistically significant differences（χ²=5.987,P=0.014）. Stent patency rates in 6 Months,12 Months,24 Months and 48 Months after operation were 95.3％、88.4％、79.1％and 72.1％in TIPSgroup,respectively,and 92.9％、87.5％、82.1％and 78.6％in TIPS+GCVEgroup,respectively,which indicated no significant difference（χ²=0.736,P=0.328）. Survival rates in 6 Months,12 Months,24 Months and 48 Months after operation were 93.0％、88.4％、83.7％and 72.1％in TIPSgroup,respectively,and 94.6％、92.9％、87.5％and 80.4％in TIPS+GCVEgroup,respectively,which pointed out no significant difference（χ²=2.18,P=0.094）. Conclusion The combined treatment of TIPSwith GCVEcould reduce rebleeding rate of esophageal and gastric varices,which is More effective than TIPSalone,with reliable security and satisfactory long-term efficacy.

Key words: Transjugular intrahepatic portosystemic shunt, Therapeutic em bolization, Upper gastrointestinal bleeding, Hypertension, portal, Esophageal and gastric varices