Viatorr覆膜支架行TIPS术的临床疗效研究

Clinical Study of TIPS in Viatorr Stent Graft

目的分析Viatorr覆膜支架在经颈静脉肝内门体分流术（TIPS）中应用的临床疗效。方法回顾性分析2016年3月至12月采用Viatorr覆膜支架行TIPS治疗的门静脉高压患者22例,主要症状表现为上消化道出血20例,顽固性腹腔积液2例。随访6-15个月,中位随访时间为11.2个月,观察患者手术并发症和临床疗效。采用配对样本t检验比较手术前后门静脉流速及压力的变化。结果 22例患者共置入Viatorr覆膜支架22枚,直径均为8 mm,支架长度为7-10 cm。。其中1例患者术中发生急性胆道损伤,经内科治疗后好转。门静脉流速由术前（17.7±7.4）cm/s升至（39.6±14.6）cm/s,门静脉压力由术前（38.4±6.6）mm H2O降为（25.2±6.4）mm H2O,差异均有统计学意义（t=9.48、-6.38,P〈0.01）。20例出血患者术后均出血停止,随访期间2例患者复发。2例顽固性腹腔积液患者腹腔积液消退,另有1例患者于术后5个月新发腹腔积液。1例（4.5%）患者发生分流道失效,通畅率95.4%（21/22）,经介入处理后达到100%。1例（4.5%）患者于术后2个月死于终末期肝病伴多器官功能衰竭。结论 Viatorr覆膜支架对于TIPS术后维持分流道通畅,减少并发症的发生及提高患者生存质量有着重要意义,但对于国内患者人群的远期疗效则有待进一步观察。

Objective To retrospectively analyse clinical efficacy of Viatorr stent grafts in transjugular intrahepatic portals system shunt（ TIPS）. Methods 22 consecutive patients with portal hypertension underwent a TIPS procedure in Viatorr stent grafts between March 2016 to December 2016,The main symptoms were variceal bleeding（ n = 20） and refractory ascites（ n = 2）. The follow-up time was 6 to 15 months,the median follow-up time was 11. 2 months,observed in patients with surgical complications and clinical efficacy. The paired t test was used for statistics. Results 22 stent-grafts were implanted in 22 patients,diameter of 8 mm,The stent length is 7-10 cm.. One patient underwent acute biliary injury during surgery,cured by medical treatment. Portal vein flow rate was increased from（ 17. 7 ± 7. 4） cm/s to（ 39. 6 ± 14. 6） cm/s and Portal venous pressure decreased significantly from（ 38. 4 ± 6. 6） mm H2 O to（ 25. 2 ± 6. 4） mm H2 O,（ t = 9. 48,-6. 38,P 0. 01）. During the follow-up period,Variceal bleeding recurrence occurred in 2 of 20 patients and one patient had ascites in five months after surgery. The primary patency rate was 95. 4%（ 21/22）. One patient（ 4. 5%） died of multisystem organ failure at 2 months postoperatively. Another patient died of splenic embolism caused by abdominal infection was not included in the above mortality rate. Conclusion Shunt patency rate is improved with placement of Viatorr stentgrafts,The increased shunt patency contributes to low repeat intervention and complication rates. However,the long-term efficacy of the patients is still to be observed in China.