采用Viatorr覆膜支架建立经颈静脉肝内门体静脉分流术的中期疗效分析

Analysis of the medium-term curative effect of transjugular intrahepatic portosystemic shunt through jugular vein with covered Viatorr stent

目的探讨经颈静脉肝内门体静脉分流术(TIPS)采用Viatorr覆膜支架建立分流道的中期疗效。方法回顾性分析南方医院连续105例采用Viatorr覆膜支架建立TIPS分流道患者资料。术后进行随访,复查彩色多普勒,评价TIPS疗效。结果所有患者均成功建立肝内分流道。术前、术后门静脉压力梯度分别为(22.33±6.4)mmHg、(9.78±4.9)mmHg,P<0.01,差异有统计学意义。随访12.7~15.6(13.09±1.4)个月。术后总胆红素及凝血时间较术前升高,术后1、3、6、12个月总胆红素及凝血时间差异无统计学意义。术后1、3、6、12个月分流道通畅率分别为100%、99.05%、99.05%、99.05%,肝性脑病的发生率分别为34.2%、29.5%、19.1%、14.3%,症状复发率均为0。结论肝硬化门静脉高压患者采用Viatorr覆膜支架行TIPS治疗的再狭窄率低,肝功能影响小,严重肝性脑病发生率低,长期疗效有待进一步观察。

Objective To investigate the medium-term curative effect of transjugular intrahepatic portosystemic shunt(TIPS)through jugular vein with covered Viatorr stent.Methods Data of 105 consecutive patients with covered Viatorr stent of our hospital was retrospectively analyzed.Follow-up was performed after surgery,and color Doppler was reviewed to evaluate the efficacy of TIPS.Results Transjugular intrahepatic shunt was successfully established in all patients.The pressure gradients of portal vein before and after operation were 22.33±6.4 mmHg and 9.78±4.9 mmHg,respectively,P<0.01,and the difference was statistically significant.The follow-up period ranged from 12.7 to 15.6 months,with an average of 13.09±1.4 month.Total bilirubin and coagulation time increased after operation,but there was no significant difference in total bilirubin and coagulation time at 1,3,6 and 12 months after operation.The patency rate of shunt was 100%,99.05%,99.05%and 99.05%at 1,3,6 and 12 months after operation.The incidence of hepatic encephalopathy was 34.2%,29.5%,19.1%and 14.3%respectively.The recurrence rate of symptoms was 0%.Conclusion Patients with cirrhotic portal hypertension who underwent TIPS with covered Viatorr stent had a lower rate of restenosis,improved liver function,and a lower incidence of severe hepatic encephalopathy.However,the long-term efficacy needs further observation.