Viatorr支架与双支架技术行经颈静脉肝内门体分流术的临床疗效观察

Clinical effect of Viatorr stent versus double-stent technique in transjugular intrahepatic portosystemic shunt

目的观察Viatorr支架与双支架技术行经颈静脉肝内门体分流术(TIPS)的临床疗效。方法收集2015年5月-2016年12月于安徽医科大学第一附属医院介入放射科行TIPS治疗的62例门静脉高压患者临床资料,主要表现为上消化道出血55例和顽固性腹水7例。根据术中应用覆膜支架类型分为Viatorr支架组(n=22)和双支架组(裸支架+Fluency覆膜支架,n=40)。术后随访6~17个月,观察分流道通畅率、肝性脑病发生率及病死率。计量资料2组间比较采用独立样本t检验,组内比较采用配对样本t检验;计数资料2组间比较采用χ~2检验。结果 62例患者TIPS手术均成功,共置入Viatorr支架22枚,裸支架40枚,Fluency覆膜支架40枚,直径均为8 mm。Viatorr支架组和双支架组门静脉压力分别由术前(28.7±4.9)mm Hg和(27.2±4.3)mm Hg降至(18.7±4.7)mm Hg和(18.8±3.9)mm Hg,差异均有统计学意义(t值分别为9.9、13.5,P值均<0.01)。55例消化道出血患者术后均停止出血,7例顽固性腹水患者腹水消退。Viatorr支架组和双支架组通畅率分别为95.5%、90.0%,肝性脑病发生率分别为9%、15%,随访期间病死率分别为4.5%和12.5%,差异均无统计学意义(P值均>0.05)。结论采用Viatorr支架或双支架技术行TIPS疗效确切,但采用Viatorr建立TIPS分流道近期疗效与双支架技术无明显差别,其较双支架技术的优势需进一步探究。

Objective To investigate the clinical effect of Viatorr stent versus double-stent technique in transjugular intrahepatic portosystemic shunt（ TIPS）. Methods A total of 62 patients with portal hypertension who underwent TIPS in Department of Interventional Radiology,The First Affiliated Hospital of Anhui Medical University,from May 2015 to December 2016 were enrolled,among whom 55 had a major symptom of upper gastrointestinal bleeding and 7 had intractable ascites. According to the type of covered stent used in the surgery,the patients were divided into Viatorr stent group with 22 patients and double-stent group with 40 patients（ bare stent ＋ Fluency covered stent）.The patients were followed for 6-17 months after surgery,and the shunt patency rate,incidence rate of hepatic encephalopathy,and mortality rate were determined. The independent samples t-test or the paired samples t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. Results All patients underwent TIPS successfully,and a total of 22 Viatorr stents,40 bare stents,and 40 Fluency covered stents,with a diameter of 8 mm,were implanted. Portal venous pressure was significantly reduced from 28. 7 ± 4. 9 mm Hg before surgery to 18. 7 ± 4. 7 mm Hg after surgery in the Viatorr stent group（ t = 9. 9,P 0. 01） and from 27. 2 ± 4. 3 mm Hg before surgery to 18. 8 ± 3. 9 mm Hg after surgery in the double-stent group（ t = 13. 5,P 0. 01）. Gastrointestinal bleeding was stopped for all 55 patients with upper gastrointestinal bleeding,and 7 patients with intractable ascites achieved ascites regression. The patency rate was 95. 5% in the Viatorr stent group and 90. 0% in the double-stent group,the incidence rate of hepatic encephalopathy was 9% in the Viatorr stent group and 15% in the double-stent group,and the mortality rate was 4. 5% in the Viatorr stent group and 12. 5% in the double-stent group; there were no significant differences between the two groups（ all P 0. 05）. Conclusion Both Viatorr stent and double-stent technique have a good clinical effect in TIPS,and the short-term outcome of TIPS shunt established by Viatorr stent is similar to that of TIPS shunt established by double-stent technique. Further studies are needed to investigate the advantages of Viatorr stent over double-stent technique.