采用Fluency、Viatorr覆膜支架行TIPS治疗乙型肝炎肝硬化门静脉高压的临床分析

Efficacy of TIPS with Fluency or Viatorr covered stents in portal hypertension caused by hepatitis B cirrhosis

目的 回顾Fluency、Viatorr覆膜支架行颈静脉肝内门体分流术(TIPS)治疗乙肝肝硬化并发门静脉高压症患者的临床资料,比较两者的临床疗效及转归。方法 选取2015年6月—2021年1月北海市人民医院收治并采用Fluency、Viatorr覆膜支架行TIPS治疗的乙肝肝硬化并发门静脉高压症患者110例。其中,男性77例,女性33例,年龄37~74岁。根据支架类型分为Fluency组、Viatorr组,分别有77例和33例。比较两组患者一般资料、支架狭窄、支架闭塞及再次施行TIPS手术间隔时间及TIPS治疗前后门静脉压力,随访后比较两组患者并发症、病死原因。结果 患者中临床症状为门静脉高压症引起上消化道出血95例(86.4%)、顽固性腹水15例(13.6%)。治疗结束后,110例患者中26例(23.6%)出现支架狭窄、23例出现闭塞(20.9%)。其中Fluency组肝静脉端15例(19.5%)、门静脉端血栓形成8例(10.4%)、肝静脉端6例(7.8%)、门静脉端迂曲打折5例(6.5%);Viatorr组肝静脉端3例(9.1%)、门静脉端血栓形成1例(3.0%)、肝静脉端迂曲打折1例(3.0%)。Viatorr组支架狭窄率、支架闭塞率低于Fluency组(P <0.05)。Viatorr组再次施行TIPS手术间隔时间长于Fluency组(P <0.05)。Fluency组、Viatorr组TIPS治疗前门静脉压力均高于治疗后(P <0.05)。随访6~17个月,患者TIPS治疗后常见并发症包括恶心和呕吐17例(15.5%)、穿刺部位出血10例(9.1%)、暂时性呼吸窘迫和心动过速4例(3.6%)、腹腔内出血3例(2.7%)及胆道出血1例(0.9%)。随访期间病死患者15例(13.6%),其中肝衰竭9例(8.2%)、严重肝性脑病4例(3.6%)及复发性曲张静脉出血2例(1.8%)。两组并发症、病死原因比较,差异无统计学意义(P>0.05)。结论 采用Viatorr支架行TIPS治疗支架狭窄或闭塞发生率较低,不过Fluency、Viatorr支架近期疗效、并发症无明显差异,还需进一步探究。

Objective To review the clinical data of patients with hepatitis B cirrhosis complicated with portal hypertension undergoing transjugular intrahepatic portosystemic shunt(TIPS) with Fluency or Viatorr covered stents were reviewed,and to compare the clinical efficacy and the outcome in patients receiving the two different treatment modalities.Methods From June 2015 to January 2021,a total of 110 patients with hepatitis B cirrhosis complicated with portal hypertension undergoing TIPS with Fluency or Viatorr covered stents were collected,including 77 males and 33 females with the age ranged 37 to 74 years old.They were divided into Fluency group and Viatorr group according to stent types,and the general data,the incidence of stenosis and occlusion of the TIPS stents,the time to a second TIPS,and portal venous pressure before and after the treatment were compared between the two groups.The patients were further followed up to determine and compare the incidence of complications and the cause of mortality between the two groups.Results Regarding the clinical symptoms,95 cases(86.4%) were present with upper gastrointestinal bleeding caused by portal hypertension,while there were 15 cases(13.6%) of refractory ascites.After the treatment,stenosis and occlusion of the TIPS stents occurred in 26 cases(23.6%) and 23cases(20.9%) out of the 110 patients,respectively.There were 15 cases(19.5%) and 8 cases(10.4%) of hepatic vein thrombosis and portal vein thrombosis,and 6 cases(7.8%) and 5 cases(6.5%) of hepatic vein tortuosity and portal vein tortuosity occurring in the Fluency group,while there were 3 cases(9.1%) and 1 case(3.0%) of hepatic vein thrombosis and portal vein thrombosis,and 1 case(3.0%) of hepatic vein tortuosity occurring in the Fluency group.The rates of stenosis and occlusion of the TIPS stents in the Viatorr group were lower than those in the Fluency group(P<0.05).The time to a second TIPS in the Viatorr group was longer than that in the Fluency group(P<0.05).The portal venous pressure before the treatment were higher than those after the treatment in both the Fluency group and the Viatorr group(P<0.05).After 6 to 17 months of follow-up,common complications including 17 cases of nausea and vomiting(15.5%),10 cases of hemorrhage at the puncture site(9.1%),4 cases of transient respiratory distress(3.6%),3 cases of intraperitoneal hemorrhage(2.7%),and 1 case of hemobilia(1.0%) were observed in patients undergoing TIPS.A total of 15 mortalities occurred during the follow-up period,where the death causes included 9 cases of hepatic failure(8.2%),4 cases of severe hepatic encephalopathy(3.6%),and 2 cases of recurrent variceal hemorrhage(1.8%).There was no difference in the complications and death causes between the two groups(P>0.05).Conclusions The incidence of stenosis and occlusion of the TIPS stents is low when Viatorr covered stents were applied.However,there is no obvious difference in short-term efficacy and complications between patients undergoing TIPS with Fluency and Viator covered stents,which awaits further investigation.