覆膜支架和裸支架行TIPS治疗门静脉高压症的对比研究

The retrospective study of transjugular intrahepatic portosystemic shunt with covered or uncovered stents in patients with portal hypertension

目的比较研究覆膜支架移植物和裸支架在经颈内静脉肝内门体分流术（TIPS）治疗门静脉高压症中的临床疗效。方法2007年4月至2009年4月，采用覆膜支架移植物行。TIPS治疗门静脉高压症患者30例（A组），同期采用裸支架行TIPS治疗30例（B组），观察两组患者的肝功能、门静脉血流变化及临床疗效。结果住院期间两组均未出现出血和肝性脑病，各出现分流道急性阻塞1例。A组术后随访（6．2±3．9）个月，13组术后随访（8．34-4．4）个月，A组和B组的再出血率、分流道阻塞率、肝性脑病发生率和病死率分别为3．3％和20．0％、0和30．0％、16．7％和20．0％、0和13．3％，A组再出血率、分流道阻塞率和病死率低于B组（P〈0．05），肝性脑病发生率无差异（P〉0．05）。A组门静脉压力、门体压力梯度下降程度、门静脉血流增快程度、分流道血流速率高于B组（P〈0．05），两组肝功能、血氨及MELD评分无差异（P〉0．05）。结论覆膜支架移植物能显著提高分流道通畅率，降低出血复发率，提高TIPS治疗门静脉高压症的疗效。

Objective To retrospectively compare the clinical outcome in patients with portal hypertension treated with transjugular intrahepatic portosystemic shunt （TIPS） using Fluency stent-graft （FFFE-covered stents） or bare stents. Methods Approval of study and treatment protocol and waiver of informed consent for the retrospective study were obtained from institutional review board. Informed consent was obtained from each patient before procedure. Sixty consecutive patients with portal hypertension treated with TIPS from April 2007 to April 2009 were included. TIPS creation was performed with Fluency stent-graft in 30 patients （group A） and with bare stents in 30 patients （group B）. Liver function, TIPS patency and clinical outcome were evaluated every 3 months. Results During hospitalization, there was no hepatic encephalopathy and recurrency of variceal bleeding. Acute shunt occlusion was observed in one patient with group A and another patient with group B. Follow-up was performed with average time of （ 6. 2 ±3.9） months in group A and （8.3 ± 4.4） months in group B. The rates of recurrent bleeding, acute shunt occlusion,hepatic encephalopathy and death were 3.3% and 20. 0%, 0 and 30.0%, 16. 7% and 20. 0%, 0 and 13.3% in group A and B. The rates of recurrent bleeding,acute shunt occlusion and death in group A was lower than those in group B. There was no difference of hepatic encephalopathy between group A and B. The decrease of portal pressure and portosystemic pressure gradient, and the increase of portal flow and shunt flow in group A were higher than those in group B. There were no difference of liver function, ammonia and MELD between group A and B. Conclusions Fluency stent-graft is safe and effective in TIPS creation, with high patency rate. Covered-stent can improve the clinical outcome of portal hypertension.