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经颈静脉肝内门体分流术后支架功能障碍的原因分析及处理策略
Stent dysfunction after transjugular intrahepatic portosystemic shunt: Causes and countermeasures
文章发布日期:2019年04月04日  来源:  作者:姚欣,周昊,汤善宏,等  点击次数:404次  下载次数:84次

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【摘要】:目的探讨经颈静脉肝内门体分流术(TIPS)术后COOK裸支架、Wallgraft覆膜支架和Fluency覆膜支架3种血管支架出现功能障碍的原因及处理策略。方法收集2011年1月-2017年7月于西部战区总医院随访的支架功能障碍并行TIPS修正术患者54例的临床资料。术中通过造影及门静脉压力的情况,选择球囊扩张术、同轴支架置入术和平行TIPS术修正支架功能障碍。采用Kruskal-Wallis H检验比较3种支架狭窄或闭塞时间,采用配对t检验比较修正前后PVP。通过影像学资料判断支架功能障碍情况,分析支架狭窄或闭塞的原因。结果54例患者全部成功实施TIPS修正,狭窄部位分别发生在肝静脉段、肝实质或门静脉段,高发时间窗为术后6~24个月。COOK支架、Wallgraft支架、Fluency支架狭窄或闭塞中位时间分别为17.0、10.0、17.0个月。COOK支架和Fluency支架发生狭窄或闭塞时间晚于Wallgraft支架(P值分别为0.013、0.023),COOK支架和Fluency支架发生狭窄或闭塞时间差异无统计学意义(P=0.893)。应用修正术式方面,球囊扩张4例,同轴支架置入39例,平行TIPS 11例,所有患者术后门静脉压力明显低于术前,差异有统计学意义[(256±48) cm H2O vs (34.7±64) cm H2O,P<0.001]。结论TIPS术后Wallgraft支架功能障碍时间明显早于COOK祼支架、Fluency支架,提示Wallgraft支架不适用于TIPS分流道的初始创建。术中根据具体状况选择适宜的修正术式,均能够修复支架功能障碍,恢复分流道通畅。
【Abstract】:ObjectiveTo investigate the causes of dysfunction of COOK bare stent, Wallgraft covered stent, and Fluency covered stent after transjugular intrahepatic portosystemic shunt (TIPS) and related countermeasures. MethodsThe clinical data of 54 patients who were found to have stent dysfunction and underwent TIPS correction in our hospital from January 2011 to July 2017 were collected. Balloon dilatation, coaxial stent implantation, or parallel TIPS was selected based on angiography results and portal venous pressure to repair stent dysfunction. The Kruskal-Wallis H test was used to compare in-stent restenosis or occlusion time between the three types of stents, and the paired t-test was used to compare portal vein perfusion (PVP) before and after correction. Radiological examination was performed to evaluate stent dysfunction, and the cause of in-stent restenosis or occlusion was analyzed. ResultsTIPS correction was successfully performed for all 54 patients. Stenosis was observed in the hepatic vein, the liver parenchyma, or the portal vein, and there was a high incidence rate within 6-24 months after surgery. The median time to stenosis or occlusion was 17.0 months for COOK bare stent, 10.0 months for Wallgraft covered stent, and 17.0 months for Fluency covered stent. COOK bare stent and Fluency covered stent had a longer time to stenosis or occlusion than Wallgraft covered stent (P=0.013 and 0.023), and there was no significant difference in the time to stenosis or occlusion between COOK bare stent and Fluency covered stent (P=0.893). As for the surgical procedure of TIPS correction, 4 patients underwent balloon dilatation, 39 underwent coaxial stent implantation, and 11 underwent parallel TIPS. There was a significant reduction in portal venous pressure after surgery (25.6±4.8 cm H2O vs 34.7±6.4 cm H2O, P<0.001). ConclusionWallgraft stent has a significantly shorter time to stent dysfunction after TIPS than COOK bare stent and Fluency covered stent, suggesting that Wallgraft stent is not suitable for the initial establishment of TIPS shunt. Correction procedures should be selected based on actual conditions to repair stent dysfunction and restore shunt patency.
【关键字】:高血压, 门静脉; 门体分流术, 经颈静脉肝内; 支架; 横断面研究
【Key words】:hypertension, portal; portasystemic shunt, transjugular intrahepatic; stents; cross-sectional studies
【引证本文】:YAO X, ZHOU H, TANG SH, et al. Stent dysfunction after transjugular intrahepatic portosystemic shunt: Causes and countermeasures[J]. J Clin Hepatol, 2019, 35(5): 1052-1056. (in Chinese)
姚欣, 周昊, 汤善宏, 等. 经颈静脉肝内门体分流术后支架功能障碍的原因分析及处理策略[J]. 临床肝胆病杂志, 2019, 35(5): 1052-1056.

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