抗凝药物在预防TIPSS术后分流道狭窄治疗中的临床应用和选择

Clinical application of anticoagulant in the prophylaxis and treatment of shunt stenosis after transjugular intrahepatic portosystemic stent shunt

目的:研究抗凝药物在经颈静脉穿刺肝内门腔静脉分流术(transjugularintrahepaticportosystemicstentshunt,TIPSS)术后预防和治疗分流道异常中的临床应用。方法:通过回顾性分析在我院接受过TIPSS治疗患者术后服用抗凝药物阿司匹林、华法林治疗情况,对比随访期间出现分流道异常的发生几率。结果:TIPSS术后1周、3个月抗凝治疗对分流道有无异常影响不大;术后6个月抗凝治疗有效,但两种抗凝药物之间差异无显著性;术后12个月及以后阿司匹林抗凝作用疗效和非抗凝组之间差异无显著性,而服用华法林组仍然存在较高的分流道通畅率,具有统计学意义。结论:TIPSS术后合理应用抗凝药物可有效降低分流道狭窄和(或)闭塞,提高近期和中期临床疗效,但远期疗效仍需进一步研究。

Objective To study the clinical application of anticoagulant in the prophylaxis and treatment of shunt stenosis after transjugular intrahepatic portosystemic stent shunt （TIPSS）. Methods The status of patients receiving aspirin and warfarin after TIPSS was retrospectively analyzed. And the incidence of runner stenosis was analyzed. Results Anticoagulant therapy had no obvious effect on the shunt 1 week and 3 mouths after TIPSS, but had significant effect 6 months after TIPSS. There was no significant difference between the two coagulants. Warfarin was effective in preventing stenosis and occlusion of shunt 12 months after TIPSS. Conclusion Reasonable application of anticoagulant after TIPSS can effectively reduce the stenosis and occlusion rate of shunt, and increase clinical curative effect of near and metaphase.