摘要
目的 评价裸支架联合Fluency覆膜支架行经颈静脉肝内门体静脉分流术(TIPS)治疗门静脉高压症的远期效果和价值.方法 回顾性分析2012年8月至2017年12月因顽固性腹水或肝硬化门静脉高压所致门静脉高压食管胃底静脉曲张破裂出血(EGVB)在新疆医科大学第一附属医院和丽水市中心医院接受裸支架联合覆膜支架行TIPS治疗的29例患者临床资料.定期随访观察患者生存情况.采用Kaplan-Meier法分析患者术后分流道累积通畅率和累积生存率.结果 TIPS技术成功率为100％.门静脉压力由术前(40.21±3.24)cmH2O 下降至术后(24.55±3.55)cmH2O(P＜0.05).随访 5.1～10.5 年.术后1、3、5、7年分流道一期累积通畅率分别为89.7％、75.9％、75.9％、52.5％,5、7、9、10年累积生存率分别为100％、66.9％、66.9％、33.4％.肝性脑病发生率为13.8％(4/29).结论 采用裸支架联合Fluency覆膜支架行TIPS治疗门静脉高压症安全有效,远期分流道通畅率较高,肝性脑病发生率低.必要时可作为Viatorr支架替代应用.
Abstract
Objective To evaluate the long-term efficacy of transjugular intrahepatic portosystemic shunt(TIPS)with bare stents and Fluency covered stents in the treatment of portal hypertension,and to discuss its clinical value.Methods The clinical data of 29 patients with intractable ascites or esophagogastric fundus varices rupture and hemorrhage caused by cirrhotic portal hypertension,who received TIPS with bare stents and covered stents at the First Affiliated Hospital of Xinjiang Medical University of China(25 patients)and the Lishui Municipal Central Hospital of China(4 patients)between August 2012 and December 2017,were retrospectively analyzed.The patients were regularly followed up to check the survival status.The postoperative cumulative shunt patency rate and cumulative survival rate of the patients were analyzed by Kaplan-Meier method.Results The technical success rate of TIPS was 100％.The mean portal vein pressure was decreased from preoperative(40.21±3.24)cmH2O to postoperative(24.55±3.55)cmH2O(P＜0.05).The patients were followed up for 5.1-10.5 years.The postoperative 1-,3-,5-,7-year primary cumulative patency rates of the shunt were 89.7％,75.9％,75.9％ and 52.5％,respectively.The postoperative 5-,7-,9-and 10-year cumulative survival rates were 100％,66.9％,66.9％ and 33.4％,respectively.The incidence of hepatic encephalopathy was 13.8％(4/29).Conclusion Using bare stents combined with Fluency covered stents for TIPS is clinically safe and effective in the treatment of portal hypertension.This technique carries higher long-term shunt patency rate and low incidence of hepatic encephalopathy.Therefore,it can be used as a substitute for Viatorr stent when necessary.(J Intervent Radiol,2024,33:295-299)
基金项目
浙江省自然科学基金面上项目(LTGY23H180006)
浙江省医药卫生科技计划(2022501988)
浙江省医药卫生科技计划(2023KY1359)
NETL
NSTL
万方数据