小肠黏膜下层覆膜支架预防家猪经颈静脉肝内门腔静脉分流术后分流道狭窄

Small intestinal submucosa covered stent for prevention of restenosis after transjugular intrahepatic portosystemic shunt in porcines

目的探讨小肠黏膜下层(SIS)覆膜支架预防经颈静脉肝内门腔静脉分流术(TIPS)后分流道再狭窄的可行性及有效性。方法 24只长白猪被随机分成两组,实验组16只,对照组8只,建立TIPS模型。分别于术后第2周、4周行直接门静脉造影复查后处死动物,获取支架内及周围肝组织,行大体及病理组织形态学检查。结果 24只猪TIPS模型均成功建立,术后2周造影复查示实验组、对照组分流道分别闭塞1只(1/8,12.50%)、2只(2/4,50.00%),术后4周分别闭塞5只(5/8,62.50%)、4只(4/4,100%),其余均有不同程度狭窄。结论 SIS覆膜支架可有效防止TIPS术后增生的纤维组织向分流道内长入,减轻血栓形成、炎性反应、新生胆管增生及异物反应等。

Objective To observe the feasibility and effectiveness of the prevention of the restenosis after transjugular intrahepatic portosystemic shunt（TIPS）with stents covered with small intestinal submucosa（SIS）.Methods Twenty-four porcines were randomly divided into two groups：Experimental group,the stents covered with SIS were used（16 porcines）;Control group,the naked stents were used（8 porcines）.TIPS porcine models were established successfully in both groups.Shunt venography was performed 2 and 4 weeks after operation.The shunt and the hepatic tissue around were taken out in autopsy.Observation of samples was made macroscopically and microscopically.Results All 24 TIPS porcine models were established successfully.According to the portal venography performed 2 and 4 weeks after operation,12.50%（1/8）,62.50%（5/8）shunts were occluded in experimental group,and 50.00 %（2/4）,100%（4/4）shunts were occluded in control group.The rest of the shunts were restenosis in different degree.Conclusion Compared to the naked stent,SIS covered stent can partly prevent the proliferative fibrous tissue from growing into the shunt,lighten the thrombosis,cellular inflammatory reaction,proliferation of the new bile duct and the foreign body reaction.