双支架技术在经颈静脉肝内门体分流术中的应用

Application of double-stent technique in transjugular intrahepatic portal-systemic shunt

目的对比分析应用3种支架植入方式[裸支架、覆膜支架、双支架(裸支架+覆膜支架)]行经颈静脉肝内门体分流术(TIPSS)的分流效果、对肝功能的影响和中远期通畅率。方法回顾性分析因肝硬化门静脉高压合并上消化道出血行TIPSS治疗的178例患者的临床资料,比较3种支架的临床疗效、肝功能恢复时间、术后1年一期和二期通畅率。结果 178例患者中,成功植入支架175例,成功率为98.31%(175/178),其中裸支架52例,覆膜支架52例,双支架71例。所有患者的出血均得到控制。裸支架组、覆膜支架组、双支架组肝功能恢复正常时间分别为(5.3±1.4)天、(9.8±1.7)天、(6.2±1.7)天,裸支架组和双支架组与覆膜支架组的差异有统计学意义(P均<0.01),裸支架组和双支架组间差异无统计学意义(P>0.05)。裸支架组、覆膜支架组和双支架组1年一期通畅率分别为78.84%(41/52)、84.61%(44/52)、90.14%(64/71),两两比较差异均有统计学意义(P均<0.01);1年二期通畅率均为100%。结论采用双支架技术行TIPSS技术,对肝功能影响小,可提高中远期通畅率,可作为Viatorr支架的替代选择。

Objective To compare and analyze the three methods of stent placement （bare stent, stent graft and double stents [bare stent and stent graft]） in transjugular intrahepatic portal systemic shunt （TIPSS） on clinical outcome, influence on liver function and medium and long term patency. Methods Totally 178 cases of portal hypertensive hemorrhage treated by TIPSS were analyzed retrospectively. The clinical outcome, influence on liver function and medium and long term patency were compared. Results Among the 178 cases, stents were successfully demployed in 175 cases with the success rate of 98.31% （175/178）. Bare stents, stent graft and double stents were placed in 52, 52, 71 cases respectively. Bleeding was controlled in all patients. The time needed for liver function restoration were （5.3±1.4）days for bare stent group, （9.8±1.7）days for stent graft group, and （6.2±1.7）days for double stent group; there was no significant difference between the bare stent and double stent group （P〈0.05）, while the stent graft group were longer than that of the other two groups （all P〈0.01）. The one-year primary patency were 78.84% （41/52）, 84.61% （44/52）, 90.14% （64/ 71） for bare stent group, stent graft group and double stent group respectively, and the differences were significant （all P 〈0.01）. The secondary patency was 100% in each group. Conclusion Comparing with the bare stent and stent graft technique, double stent technique offers the highest meidium and long term patent rate with less liver function injury and can be a good substitution for Viatorr stent.