TIPS术中运用Viatorr支架与模拟Viatorr支架的回顾性研究

Retrospective study of Viatorr stent and simulated Viatorr stent in transjugular intrahepatic portosystemic shunt

目的观察Viatorr支架与模拟Viatorr支架行经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)的临床效果。方法收集遂宁市中心医院2017年7月至2018年2月行TIPS治疗的41例食管胃底静脉曲张破裂出血(esophagogatric variceal bleeding,EGVB)及难治性腹水患者的临床资料,按其术中使用支架类型分为Viatorr支架组(n=14)和模拟Viatorr支架组(Fluency覆膜支架与裸支架联合,n=27)。记录手术用时,术后随访1年,观察相关疗效、并发症指标。计量资料比较采用t检验,计数资料比较采用χ^2检验或Fisher确切概率法,两分类变量间关系采用双变量关联性分析。结果两组患者手术操作均成功。34例EGVB患者出血停止,止血率均为100%,7例难治性腹水患者6例腹水有缓解。两组术后门静脉压力较术前均降低,Viatorr支架组较模拟Viatorr支架组下降明显,差异有统计学意义(P<0.05)。手术用时分别为(99.4±9.7)min、(109.2±8.6)min;失效率分别为0、29.6%,差异均有统计学意义(P<0.05)。Viatorr支架组和模拟Viatorr支架组肝性脑病发生率分别为42.9%、40.7%;肝性脊髓病发生率分别为0、3.7%;病死率分别为7.1%、7.4%,差异无统计学意义(P>0.05)。顽固性腹水、肝性脊髓病、肝衰竭与死亡的双变量关联性分析差异有统计学意义(P<0.01)。结论TIPS术中运用Viatorr支架较模拟Viatorr支架门静脉压力下降明显,手术用时及分流道失效率低;在止血效果、肝性脑病与肝性脊髓病发生率及病死率方面差异无统计学意义。顽固性腹水、肝性脊髓病、肝衰竭是TIPS术后死亡的危险因素。

Objective To observe the clinical effect of Viatorr stent and simulated Viatorr stent in transjugular intrahepatic portosystemic shunt(TIPS).Methods The clinical data of 41 patients with esophagogastric variceal bleeding(EGVB)and refractory ascites treated with TIPS in Suining Central Hospital from Jul.2017 to Feb.2018 were collected.The patients were divided into Viatorr stent group(n=14)and simulated Viatorr stent group(Fluency covered stent combined with bare-metal stent,n=27)according to the stent type during surgery.Surgical duration was recorded.Postoperative follow-up was performed for 1 year to observe relevant efficacy and complications.Measurement data were compared by the t test and counting data by the χ^2 test or Fisher’s exact probability test.The correlation between two categorical variables was analyzed by bivariate correlation analysis.Results The surgery was successful in both two groups.Bleeding was stopped in 34 patients with EGVB,with a hemostasis rate of 100%.In the 7 patients with refractory ascites,6 patients were relieved.Postoperative portal vein pressure in the Viatorr stent group and simulated Viatorr stent group was lower than that before operation.The Viatorr stent group was significantly lower than the simulated Viatorr group,and the difference was statistically significant(P<0.05).Surgical duration was(99.4±9.7)min and(109.2±8.6)min,respectively.Failure rate was 0 and 29.6%,respectively,with statistically significant differences(P<0.05).The incidence of hepatic encephalopathy was 42.9%and 40.7%,the incidence of hepatic myelopathy was 0 and 3.7%,and the mortality was 7.1%and 7.4%in the Viatorr stent group and simulated Viatorr stent group,respectively,with no statistically significant differences(P>0.05).Bivariate correlation analysis of refractory ascites,hepatic myelopathy,hepatic failure and death demonstrated statistical significance(P<0.01).Conclusion Application of Viatorr stent in TIPS presents significantly reduced portal vein pressure,shorter surgical duration and lower shunt failure rate compared with simulated Viatorr stent.No differences are found in hemostatic effect,the incidence of hepatic encephalopathy and hepatic myelopathy,or mortality.Refractory ascites,hepatic myelopathy and hepatic failure are risk factors for mortality after TIPS.