限流支架治疗经颈静脉肝内门体分流术后复发性或持续性显性肝性脑病的效果和安全性

何创业; 陈辉; 吕勇; 夏冬东; 余天垒; 袁旭龙; 李凯; 王钲钰; 牛静; 白苇; 郭文刚; 帖君; 殷占新; 韩国宏

doi:10.3969/j.issn.1001-5256.2019.08.014

限流支架治疗经颈静脉肝内门体分流术后复发性或持续性显性肝性脑病的效果和安全性

DOI: 10.3969/j.issn.1001-5256.2019.08.014

空军军医大学第一附属医院消化内科

基金项目:

陕西省重点研发计划项目(S2018-YF-YBSF-0554)；

详细信息

中图分类号: R575.3
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出版历程
- 收稿日期: 2019-03-08
- 出版日期: 2019-08-20

Safety and efficacy of flow-reducing stent in treatment of recurrent or persistent hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

Department of Gastroenterology, The First Affiliated Hospital of Air Force Medical University

Research funding:

摘要

摘要:
目的分析限流支架治疗经颈静脉肝内门体分流术（TIPS）后复发性或持续性肝性脑病的效果和安全性。方法选取空军军医大学第一附属医院2013年1月-2018年8月TIPS术后明确诊断为持续性或复发性显性肝性脑病的患者11例。限流支架置入前后选用客观量表对肝性脑病患者进行准确评估。限流支架应尽量选择同类型和合适长度的金属覆膜支架,术中术后常规门静脉造影并测门静脉压力梯度。主要观察终点为肝性脑病的变化情况。采用配对t检验分析手术前后各项检测指标的变化。结果11例患者均成功置入限流支架,限流支架置入后1周内8例患者肝性脑病消失,2例患者降为1级,其中1例患者因肝硬化严重并发肝衰竭,肝性脑病改善不明显。直径4 mm限流支架2例,5 mm 8例,6 mm 1例,限流术后门静脉压力梯度升高[（6. 09±0. 70）mm Hg vs （15. 36±2. 94） mm Hg,t=2. 53,P=0. 003 8]。限流术后数字编码测试所需的时间较术前有显著下降[（269±80） s vs（464±90） s,t=2. 94,P=0. 001]。术后1个月患者Alb改善显著（t=1. 75,P=0. 01...
- 肝性脑病 /
- 门体分流术,经颈静脉肝内 /
- 支架 /
- 治疗学
Abstract:
Objective To investigate the safety and efficacy of flow-reducing stent in the treatment of recurrent or persistent hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) . Methods A total of 11 patients who were diagnosed with recurrent or persistent HE after TIPS in The First Affiliated Hospital of Air Force Medical University from January 2013 to August 2018 were enrolled. Objective scales were used to evaluate the patients with HE before and after the implantation of flow-reducing stent. Metal covered stents with the same type and an appropriate length were selected as the flow-reducing stents, and conventional portal venography and hepatic venous pressure gradient measurement were performed during and after surgery. The primary endpoint was the change in HE. The paired t-test was used to analyze the changes in related indices after surgery. Results All 11 patients underwent successful implantation of the flow-reducing stent. Within 1 week after implantation, 8 patients had disappearance of HE and 2 had HE reduced to grade 1, among whom 1 had no marked improvement in HE due to severe liver cirrhosis and liver failure. Of all patients, 2 used the 4-mm flow-reducing stent, 8 used the 5-mm flow-reducing stent, and 1 used the 6-mm flow-reducing stent, and there was a significant increase in hepatic venous pressure gradient after surgery [ (6. 09 ± 0. 70) mm Hg vs (15. 36 ± 2. 94) mm Hg, t = 2. 53, P = 0. 003 8]. There was a significant reduction in the time for digital coding test after surgery [ (269 ± 80) s vs (464 ± 90) s, t = 2. 94, P = 0. 001]. The patients had a significant improvement in albumin at 1 month after surgery (t = 1. 75, P = 0. 013) . The 2 patients receiving the 4-mm flow-reducing stent died of gastrointestinal bleeding at 6 and 12 months after surgery, respectively; among the 8 patients receiving the 5-mm flow-reducing stent, 2 experienced rebleeding at 3 months after surgery, 1 experienced massive ascites at 15 months after surgery, and 1 died of jaundice, intrac-table ascites, and liver failure at 2 years after surgery; the 1 patient receiving the 6-mm flow-reducing stent died of acute-on-chronic liver failure on day 25 after surgery. Conclusion Flow-reducing stent can effectively improve recurrent or persistent HE after TIPS and is safe and feasible; however, a small diameter of stent may lead to increased portal hypertension due to stent restenosis.
- hepatic encephalopathy /
- portasystemic shunt, transjugular intrahepatic /
- stents /
- therapeutics

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参考文献(11)

[1] CHEN Q, ZHANG Y, YUE ZD, et al. Clinical efficacy of transjugular intrahepatic portosystemic shunting for recurrent portal hypertension after liver transplantation[J]. Chin J Dig Surg, 2018, 17 (10) :1013-1017. (in Chinese) 陈权, 张裕, 岳振东, 等.经颈静脉肝内门体分流术治疗肝移植术后再发门静脉高压症的临床疗效[J].中华消化外科杂志, 2018, 17 (10) :1013-1017.

[2] DING ZF, YIN SW. Application of Viatorr covered stent in transjugular intrahepatic portosystemic shunt[J]. J Clin Hepatol, 2018, 34 (5) :1107-1110. (in Chinese) 丁智锋, 殷世武. Viatorr覆膜支架在经颈静脉肝内门体分流术中的应用现状[J].临床肝胆病杂志, 2018, 34 (5) :1107-1110.

[3] ROSSLE M. TIPS:25 years later[J]. J Hepatol, 2013, 59 (5) :1081-1093.

[4] RIGGIO O, ANGELONI S, SALVATORI M, et al. Incidence, natural history, and risk factors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene-covered stent grafts[J]. Am J Gastroenterol, 2008, 103 (11) :2738-2746.

[5] RIGGIO O, MASINI A, EFRATI C, et al. Pharmacological prophylaxis of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt:A randomized controlled study[J]. J Hepatol, 2005, 42 (5) :674-679.

[6] CHU JG, SUN XL, PIAO LS, et al. The reducing stent:Treatment for transjugular intrahepatic portosystemic shunt-induced refractory hepatic encephalopathy[J]. J General Hospital Air Force, PLA, 2002, 18 (3) :125-128. (in Chinese) 褚建国, 孙晓丽, 朴龙松, 等.限流支架植入治疗TIPS引起的难治性肝性脑病[J].空军总医院学报, 2002, 18 (3) :125-128.

[7] VILSTRUP H, AMODIO P, BAJAJ J, et al. Hepatic encephalopathy in chronic liver disease:2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver[J]. Hepatology, 2014, 60 (2) :715-735.

[8] BAI M, QI X, YANG Z, et al. Predictors of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in cirrhotic patients:A systematic review[J]. J Gastroenterol Hepatol, 2011, 26 (6) :943-951.

[9] PEREIRA K, CARRION AF, MARTIN P, et al. Current diagnosis and management of post-transjugular intrahepatic portosystemic shunt refractory hepatic encephalopathy[J]. Liver Int, 2015, 35 (12) :2487-2494.

[10] WANG Q, LV Y, BAI M, et al. Eight millimeter covered TIPS does not compromise shunt function but reduces hepatic encephalopathy in preventing variceal rebleeding[J]. J Hepatol, 2017, 67 (3) :508-516.

[11] GARCIA-PAGAN JC, CACA K, BUREAU C, et al. Early use of TIPS in patients with cirrhosis and variceal bleeding[J]. N Engl J Med, 2010, 362 (25) :2370-2379.

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