Viatorr支架与双支架技术行经颈静脉肝内门体分流术的临床疗效观察

丁智锋; 殷世武; 张国兵; 汪名权; 潘升权

doi:10.3969/j.issn.1001-5256.2018.03.026

Viatorr支架与双支架技术行经颈静脉肝内门体分流术的临床疗效观察

DOI: 10.3969/j.issn.1001-5256.2018.03.026

1. 安徽医科大学附属合肥医院介入与血管外科
2. 安徽医科大学第一附属医院介入科

基金项目:

合肥市科技局基金(YW201512010005)；

详细信息

中图分类号: R575.2
计量
- 文章访问数: 2762
- HTML全文浏览量: 84
- PDF下载量: 411
- 被引次数: 0
出版历程
- 出版日期: 2018-03-20

Clinical effect of Viatorr stent versus double-stent technique in transjugular intrahepatic portosystemic shunt

Department of Interventional Radiology and Vascular Surgery, Hefei Hospital Affiliated to Anhui Medical University

Research funding:

摘要

摘要:
目的观察Viatorr支架与双支架技术行经颈静脉肝内门体分流术（TIPS）的临床疗效。方法收集2015年5月-2016年12月于安徽医科大学第一附属医院介入放射科行TIPS治疗的62例门静脉高压患者临床资料,主要表现为上消化道出血55例和顽固性腹水7例。根据术中应用覆膜支架类型分为Viatorr支架组（n=22）和双支架组（裸支架+Fluency覆膜支架,n=40）。术后随访617个月,观察分流道通畅率、肝性脑病发生率及病死率。计量资料2组间比较采用独立样本t检验,组内比较采用配对样本t检验;计数资料2组间比较采用χ2检验。结果 62例患者TIPS手术均成功,共置入Viatorr支架22枚,裸支架40枚,Fluency覆膜支架40枚,直径均为8 mm。Viatorr支架组和双支架组门静脉压力分别由术前（28.7±4.9）mm Hg和（27.2±4.3）mm Hg降至（18.7±4.7）mm Hg和（18.8±3.9）mm Hg,差异均有统计学意义（t值分别为9.9、13.5,P值均<0.01）。55例消化道出血患者术后均停止出血,7例顽...
- 高血压,门静脉 /
- 门体分流术,经颈静脉肝内 /
- Viatorr覆膜支架 /
- 治疗结果
Abstract:
Objective To investigate the clinical effect of Viatorr stent versus double-stent technique in transjugular intrahepatic portosystemic shunt ( TIPS) . Methods A total of 62 patients with portal hypertension who underwent TIPS in Department of Interventional Radiology, The First Affiliated Hospital of Anhui Medical University, from May 2015 to December 2016 were enrolled, among whom 55 had a major symptom of upper gastrointestinal bleeding and 7 had intractable ascites. According to the type of covered stent used in the surgery, the patients were divided into Viatorr stent group with 22 patients and double-stent group with 40 patients ( bare stent + Fluency covered stent) .The patients were followed for 6-17 months after surgery, and the shunt patency rate, incidence rate of hepatic encephalopathy, and mortality rate were determined. The independent samples t-test or the paired samples t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Results All patients underwent TIPS successfully, and a total of 22 Viatorr stents, 40 bare stents, and 40 Fluency covered stents, with a diameter of 8 mm, were implanted. Portal venous pressure was significantly reduced from 28. 7 ± 4. 9 mm Hg before surgery to 18. 7 ± 4. 7 mm Hg after surgery in the Viatorr stent group ( t = 9. 9, P < 0. 01) and from 27. 2 ± 4. 3 mm Hg before surgery to 18. 8 ± 3. 9 mm Hg after surgery in the double-stent group ( t = 13. 5, P < 0. 01) . Gastrointestinal bleeding was stopped for all 55 patients with upper gastrointestinal bleeding, and 7 patients with intractable ascites achieved ascites regression. The patency rate was 95. 5% in the Viatorr stent group and 90. 0% in the double-stent group, the incidence rate of hepatic encephalopathy was 9% in the Viatorr stent group and 15% in the double-stent group, and the mortality rate was 4. 5% in the Viatorr stent group and 12. 5% in the double-stent group; there were no significant differences between the two groups ( all P> 0. 05) . Conclusion Both Viatorr stent and double-stent technique have a good clinical effect in TIPS, and the short-term outcome of TIPS shunt established by Viatorr stent is similar to that of TIPS shunt established by double-stent technique. Further studies are needed to investigate the advantages of Viatorr stent over double-stent technique.
- hypertension, portal /
- portasystemic shunt, transjugular intrahepatic /
- Viatorr stent graft /
- treatment outcome

HTML全文

参考文献(14)

[1]Interventional Group, Chinese Society of Radiology, Chinese Medical Association.Expert consensus on transjugular intrahepatic portosystemic shunt[J].J Clin Hepatol, 2017, 33 (7) :1218-1228. (in Chinese) 中华医学会放射学分会介入学组.经颈静脉肝内门体分流术专家共识[J].临床肝胆病杂志, 2017, 33 (7) :1218-1228.

[2]THORNBURG B, DESAI K, HICKEY R, et al.Pretransplantation portal vein recanalization and transjugular intrahepatic portosystemic shunt creation for chronic portal vein thrombosis:final analysis of a61-patient cohort[J].J Vasc Interv Radiol, 2017, 28 (12) :1714-1721.

[3]GEEROMS B, LALEMAN W, LAENEN A, et al.Expanded polytetrafluoroethylene-covered stent-grafts for transjugular intrahepatic portosystemic shunts in cirrhotic patients:long-term patency and clinical outcome results[J].Eur Radiol, 2017, 27 (5) :1795-1803.

[4]HU P, CHEN SL, LUO ZL, et al.Medium-long efficacy in transjugular intrahepatic portalsystemic shunts utilizing bare and covered stent[J].Chin J Interv Imaging Ther, 2016, 13 (7) :394-397. (in Chinese) 胡朋, 陈斯良, 罗泽龙, 等.采用裸支架联合覆膜支架建立经颈静脉肝内门体分流术的中远期疗效[J].中国介入影像与治疗学, 2016, 13 (7) :394-397.

[5]WEBER CN, NADOLSKI GJ, WHITE SB, et al.Long-term patency and clinical analysis of expanded polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunt stent grafts[J].J Vasc Interv Radiol, 2015, 26 (9) :1257-1265.

[6]LI Z, LI L, HAN XW, et al.Orbit reconstruction of percutaneous transhepatic intrahepatic stent puncture for the shunt occlusion after transjugular intrahepatic portosystemic stent shunt[J].Chin J Dig Surg, 2016, 15 (7) :748-750. (in Chinese) 李臻, 李磊, 韩新巍, 等.经皮经肝穿刺肝内支架轨道重建治疗经颈静脉肝内门体支架分流术后分流道闭塞[J].中华消化外科杂志, 2016, 15 (7) :748-750.

[7]LI CQ, LI HL, GUO J, et al.Application of simulative Viatorr technique in TIPS with double stents[J/CD].Chin J Liver Dis:Electronic Edition, 2014, 6 (1) :50-54. (in Chinese) 李常青, 李洪璐, 郭江, 等.双支架技术在TIPS治疗中的临床应用研究[J/CD].中国肝脏病杂志:电子版, 2014, 6 (1) :50-54.

[8]HSU MC, WEBER CN, STAVROPOULOS SW, et al.Passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts and assessment of clinical outcomes[J].World J Hepatol, 2017, 9 (12) :603-612.

[9]BARRIO J, RIPOLL C, BANARES R, et al.Comparison of transjugular intrahepatic portosystemic shunt dysfunction in PTFE-covered stent-grafts versus bare stents[J].Eur J Radiol, 2005, 55 (1) :120-124.

[10]ROSSI P, SALVATORI FM, FANELLI F, et al.Polytetrafluoroethylene-covered nitinol stent-graft for transjugular intrahepatic portosystemic shunt creation:3-year experience[J].Radiology, 2004, 231 (3) :820-830.

[11]HAUSEGGER KA, KARNEL F, GEORGIEVA B, et al.Transjugular intrahepatic portosystemic shunt creation with the Viatorr expanded polytetrafluoroethylene-covered stent-graft[J].J Vasc Interv Radiol, 2004, 15 (3) :239-248.

[12]LUCA A, MIRAGLIA R, CARUSO S, et al.Short-and longterm effects of the transjugular intrahepatic portosystemic shunt on portal vein thrombosis in patients with cirrhosis[J].Gut, 2011, 60 (6) :846-852.

[13]CHEN SL, ZHAO JB, CHEN Y, et al.Influence of puncture sites of portal vein in TIPS with PTFE-covered stent on long-term clinical efficacy[J].Chin J Interv Imaging Ther, 2016, 13 (9) :530-534. (in Chinese) 陈斯良, 赵剑波, 陈勇, 等.覆膜支架TIPS术中门静脉穿刺位置对术后长期疗效的影响[J].中国介入影像与治疗学, 2016, 13 (9) :530-534.

[14]CHU JG, HUANG H.Selection of portal vein bypass vessels in transjugular intrahepatic portosystemic shunt and its clinical significance[J/CD].Chin J Inter Rad:Electronic Edition, 2013, 1 (1) :36-39. (in Chinese) 褚建国, 黄鹤.经颈静脉肝内门腔静脉支架分流术中门静脉分流支血管的选择及其临床意义[J/CD].中华介入放射学电子杂志, 2013, 1 (1) :36-39.

施引文献

资源附件(0)

访问统计