采用Viabahn支架行经颈静脉肝内门体分流术治疗肝静脉广泛闭塞布加综合征的疗效分析

Analysis of curative efficacy of transjugular intrahepatic portosystemic shunt using viabahn stent in the treatment of Budd-Chiari syndrome with extensive hepatic vein occlusion

目的探讨肝静脉广泛闭塞布加综合征(BCS)患者采用Viabahn支架行经颈静脉肝内门体分流术(TIPS)的疗效。方法回顾性分析25例采用Viabahn支架行TIPS治疗的肝静脉广泛闭塞BCS患者的手术成功率、门静脉压力梯度(PPG)、并发症以及分流道通畅率。术后行彩色多普勒超声随访。采用Kaplan-Meier曲线评估通畅率。结果TIPS技术成功率100%。PPG由术前(22.7±6.2)mmHg降至术后(9.7±2.6)mmHg(t=9.58,P<0.05)。肝性脑病发生率为8.0%(2/25),无腹腔出血等并发症。25例患者随访1~39(19.0±11.9)个月,1例患者术后3个月因肝功能衰竭死亡。术后1、2、3年首次通畅率分别为91.3%、91.3%、78.2%;再次通畅率分别为100%、92.9%、92.9%。结论采用Viabahn支架行TIPS治疗肝静脉广泛闭塞BCS可获得较好的近、中期疗效。

Objective To investigate the efficacy of transjugular intrahepatic portosystemic shunt(TIPS)using viabahn stent in patients with Budd-Chiari syndrome(BCS)with extensive hepatic vein occlusion.Methods Technical success rates,portal pressure gradient(PPG),complications and shunt patency rate of 25 cases with BCS with extensive hepatic vein occlusion treated by TIPS using viabahn stent were retrospectively analyzed.Color Doppler ultrasound was used for postoperative follow-up.Patency rates were evaluated by Kaplan-Meier curve.Results The technical success rate of TIPS was 100%.Mean PPG decreased from(22.7±6.2)mmHg preoperatively to(9.7±2.6)mmHg postoperatively(t=9.58,P<0.05).Hepatic encephalopathy incidence was 8.0%(2/25),and there were no complications such as intra-abdominal hemorrhage.Twenty-five cases were followed up for 1 to 39(mean 19.0±11.9)months,and one patient died of liver failure three months after interventional treatment.The primary patency rates at 1,2,and 3 years after interventional treatment were 91.3%,91.3%,and 78.2%,respectively,while the repatency rates were 100%,92.9%,and 92.9%,respectively.Conclusion TIPS using viabahn stent can bring better short-term and midterm curative efficacy in treatment of BCS with extensive hepatic vein occlusion.