递增式扩张分流道在肝硬化门静脉高压经颈静脉肝内门体分流术中的疗效评价

Efficacy evaluation of incremental shunt expansion in cirrhosis patients with portal hypertension after transjugular intrahepatic portosystemic shunt

目的 探讨递增式扩张分流道在肝硬化门静脉高压经颈静脉肝内门体分流术(TIPS)中的疗效。方法 选取肝硬化门静脉高压症施行TIPS治疗的68例患者资料,术中先采用直径6 mm球囊扩张,根据PPG下降情况决定是否采用直径8 mm球囊扩张者为递增扩张组(n=37),直接采用直径8 mm球囊扩张者为对照组(n=31),全部患者球囊扩张后均置入直径8 mm覆膜支架。术后1、3、6、12个月及以后每6个月进行随访,对比分析两组患者术后肝性脑病、分流道通畅率及生存率。结果 两组患者术前基线水平比较,差异无统计学意义(P>0.05)。68例患者技术成功率100%。两组患者术后中位随访时间26.6(3.3~38.8)个月,递增扩张组术后1、2、3年肝性脑病累积发生率分别为8.3%、12.6%和17.2%,对照组为22.7%、45.4%和59%,差异有统计学意义(P<0.05)。递增扩张组术后1、2、3年分流道首次累积通畅率分别为94.5%、89.8%和89.8%,对照组为96.8%、93.2%和93.2%(P=0.75)。递增扩张组术后1、2、3年累积生存率分别为91.8%、88.1%和83%,对照组为90.3%、90.3%和57.5%(P=0.34)。结论 递增式扩张与非递增式扩张分流道施行TIPS的疗效相似,但可以减少TIPS术后肝性脑病的发生率。

Objective To evaluate the efficacy of incremental shunt expansion in cirrhosis patients with portal hypertension after transjugular intrahepatic portosystemic shunt(TIPS).Methods The data of 68 cirrhosis patients with portal hypertension,who underwent TIPS,were retrospectively analyzed.In the incremental expansion group(n=37),the TIPS shunt was dilated firstly by a balloon catheter with 6 mm diameter,then dilated whether or not by balloon catheter with 8 mm diameter according to the decline of the portal pressure gradient(PPG).In the control group(n=31),the TIPS shunt was dilated directly by balloon catheter with 8 mm diameter.A covered stent with 8 mm diameter was implanted in all patients.Follow-up was performed 1,3,6 and 12 months after TIPS and every 6 months thereafter.Hepatic encephalopathy,shunt patency rates and survival rates after TIPS were compared between the two groups.Results There was no statistically significant difference between the two groups in baseline level before TIPS(P>0.05).The technical success rate of 68 patients was 100%.The median follow-up time of the two groups was 26.6(3.3~38.8)months.The cumulative 1-,2-,and 3-year incidence of hepatic encephalopathy was 8.3%,12.6%and 17.2%in the incremental expansion group,and 22.7%,45.4%and 59%in the control group,respectively(P<0.05).The cumulative 1-,2-,and 3-year incidence of primary shunt patency was 94.5%,89.8%and 89.8%in the incremental expansion group,and 96.8%,93.2%and 93.2%in the control group,respectively(P=0.75).The cumulative 1-,2-,and 3-year survival rate was 91.8%,88.1%and 83%in the incremental expansion group,and 90.3%,90.3%and 57.5%in the control group,respectively(P=0.34).Conclusion The efficacy of TIPS performed by incremental expansion is similar to that of non-incremental expansion,but incremental expansion shunt can reduce the incidence of hepatic encephalopathy after TIPS.