Viatorr覆膜支架在经颈静脉肝内门体静脉分流术中的临床应用

Clinical application of Viatorr covered stent in transjugular intrahepatic portosystemic shunt

目的探讨Viatorr覆膜支架在经颈静脉肝内门体静脉分流术(transjugular intrahepatic portosystemic shunt,TIPS)治疗肝硬化门静脉高压症的初期疗效。方法 2015年10月至2016年10月山东大学附属省立医院9例肝硬化门脉高压合并静脉曲张出血患者采用Viatorr覆膜支架行TIPS治疗,术后1~3个月复查胃镜、超声,以后每半年复查一次,所有病例术后均行彩色多普勒超声及强化CT检查,对临床疗效及并发症情况进行回顾性分析。结果 9例患者均一次性操作成功,技术成功率为100%;TIPS前后门静脉压力分别为(31.22±4.92)mmHg和(18.44±3.58)mmHg(1 mmHg=0.133 kPa,配对t检验,t=10,P<0.001),分流后门静脉压力较分流前平均降低(40.57±8.86)%。9例均获随访,随访时间为1~12个月(平均194 d)。随访过程中1例于术后148 d腹腔感染死亡;1例术后83 d出现自发性腹膜炎并感染性休克,经抗感染治疗后好转;1例术后23 d因服用阿司匹林致溃疡病出血,停用阿司匹林后,患者黑便消失;其余6例既往反复曲张静脉出血的患者,术后1~3个月复查胃镜均示曲张静脉缓解或消失,随访结束时均未出现呕血、黑便等症状。所有患者至随访结束(或死亡前)TIPS分流通道血流通畅,均未出现肝性脑病症状。结论 Viatorr覆膜支架能维持分流道的长久通畅,降低再出血率,且术后肝性脑病并发率低,为门脉高压症患者的肝内门体静脉分流提供了一种安全、有效的治疗方法。

Objective To discuss the early curative effect of Viatorr covered stent used in transjugular intrahepatic portosystemic shunt(TIPS)treating cirrhotic portal hypertension.Methods Nine cirrhotic patients with portal hypertension combined with variceal hemorrhage in Shandong Provincial Hospital Affiliated to Shandong University between October2015and October2016were included.All of them received TIPS treatment using Viatorr covered stent.They underwent gastroscopy and ultrasound re-examination at1-3months after operation and re-examined every half a year.All patients underwent color Doppler ultrasound and enhanced CT examination after operation.The clinical curative effect and complication condition were analyzed retrospectively.Results Nine patients were operated successfully in one time and the successful rate of the technique was100%.Portal pressure before and after TIPS were(31.22±4.92)mmHg and(18.44±3.58)mmHg(1mmHg=0.133kPa,pairing t test^=10,P<0.001),respectively.The pressure decreased by(40.57±8.86)%after shunt compared with before.All9cases were followed up and the follow-up visit length was1-12months(averagely194days).During the follow-up,1patient died at148d after operation due to abdominal infection;1patient got spontaneous peritonitis and infectious shock at83d after operation and got recovery with anti-infection treatment;1patient got ulcerative bleeding caused by aspirin at23d after operation and the tarry stool disappeared after stopping taking aspirin;for the other6cases with repeated varicosed vein bleeding,the gastroscope examination at1-3months after operation showed that varicosed veins were relieved or disappeared and they got no symptom including haematemesis,tarry stool till the end of the follow-up visits.All patients got smooth TIPS shunts till the end of follow-up visits(or before death)and they had no symptoms of hepatic encephalopathy.Conclusions Viatorr covered stent can maintain the long-term circulation of shunts,reduce the rebreeding rate and lower the postoperative coincidence rate of hepatic encephalopathy,so it is a safe and effective treatment method forintrahepatic portosystemic stent shunt of patients with portal hypertension.