国产镍钛合金支架在TIPSS中的应用（附28例报告）

Transjugular Intrahepatic Portosystemic Shunt using Home-made Nitinol Stent:Results in 28 Patients

报告国产镍钛合金支架应用于２８例经颈静脉肝内门腔静脉分流术（ＴＩＰＳＳ）的结果，旨在评价其临床应用的可行性。２８例中男２４例，女４例，年龄３２～６８岁，均有中度以上食管胃底静脉曲张。所用支架由单根直径为０．２８ｍｍ的镍钛合金丝编织而成，呈网状构型，直径１０ｍｍ，长７ｃｍ；支架在６℃左右时柔软、易压缩，在接近体温时恢复原形状，采用推送式导入法。结果：支架导入的技术成功率为１００％（２８／２８），每例患者仅用１个支架，导入后无游走移位及分流道早闭。建立分流后门脉压从术前的（４２．０±３．５）ｃｍＨ２Ｏ（１ｃｍＨ２Ｏ＝０．０９８ｋｐａ）降至（２３．０±２．０）ｃｍＨ２Ｏ，Ｄｏｐｐｌｅｒ超声显示门脉主干血流速度从术前（１４．０±４．５）ｃｍ／ｓ增至（５２．０±１２．５）ｃｍ／ｓ，与同期Ｗａｌｌｓｔｅｎｔ组（ｎ＝２６）病例的分流前后结果相比差别无显著性（Ｐ＞０．５）。术后２５例随访４～１６个月（平均８个月），１例于ＴＩＰＳＳ后５个月发现分流道肝静脉侧狭窄（经再通成功），其余保持通畅，无复发出血。４例术后ＭＲＩ复查所见：肝内分流道形态均清楚可见，支架区无伪影。初步结论：国产镍钛合金支架具有优良的纵向顺柔性，可压缩性好，?

To evaluate the effectiveness of a home-made prototype nitinol stent in the transjugu-lar intrahepatic portosystemic stent shunt(TIPSS),Twenty-eight patients receiving the nitinol stent forsupporting the hepatic parenchymal tract were retrospectively analyzed.24 men and 4 women,agingfrom 32 to 68 years had liver cirrhosis with portal hypertension and esophageal varices. Twenty had re-current bleeding from ruptured gastroesophageal varices. The stent is made of 0. 28mm nitinol wirewoven into a flexible self-expanding mesh 10mm in diameter and 7cm in length. When cooled to 6℃,the stent becomes soft and can be easily compressed into delivery catheter. At body temperature,it ex-pands to a preset shape. The results showed that stent placement was technically successful in all 28 pa-tients. One stent was placed in each patient,no migration or thrombus was seen. Portal vein pressurewas reduced from 42. 0±3.5cmH2O(1cmH2O=0. 098kpa) before shunting to 23. 0±2.0cmH2O afteershunting Doppler US revealed that the maximum blood flow velocity in the main portal vein increasedfrom 14.0±4.5cm/sec to 52.0±12.5/sec. Comparison of these results with those of Wallstent group(n=26)did not reveal significant difference, The mean follow-up time was 8 months (range,4～16 months).Shunt stenosis was found at the hepatic vein end of the stent in one patient and treated suc-cessfully with redilatation. MRI was performed in four patients 4～10 months after TIPSS,the shunt tract was demonstrated clearly,The results indicated that the nitinol stent can be used TIPSS with satisfactory results because it has a high degree of longitudinal flexibility,good visibility during fluo-roscopy,and no negative effect on MR imaging.