Fluency覆膜支架行TIPS术后支架狭窄原因分析  

Transjugular intrahepatic portosystemic shunt with Fluency covered stent: analysis of the causes of stent stenosis

作　　者：李松蔚[1] 李迎春[1] 闫东[1] 王家平[1] 赵睿敏[1] 童玉云[1] 姜华[1] 李琳[1] 赵洁[1] 谢雯钰 

机构地区：[1]昆明医科大学第二附属医院介入放射科,650101

出　　处：《介入放射学杂志》2015年第12期1047-1051,共5页Journal of Interventional Radiology

基　　金：云南省卫生科技计划项目(2012WS0107;2014NS0112)

摘　　要：目的分析Fluency覆膜支架行经颈静脉肝内门体分流术（TIPS）后支架狭窄发生原因,探讨术中支架最佳释放位置,以进一步提高临床疗效。方法收集2008年6月至2012年6月采用Fluency覆膜支架行TIPS治疗的肝硬化门静脉高压症患者124例,术中均仅接受1枚Fluency覆膜支架,且支架直径均为8 mm。术后3、6个月,1、2、3、4、5年定期随访行超声及多层螺旋CT检查,根据分流道狭窄诊断标准评估是否存在支架功能障碍及门静脉高压复发,必要时行直接门静脉造影,球囊扩张或支架植入修复分流道。结果 124例患者手术成功率为100%,术后门静脉内径和门静脉压力均显著降低。随访期间共有35例患者（28.23%）发生支架狭窄,其中22例为肝静脉端狭窄,12例为门静脉端狭窄,1例为支架完全闭塞;经门静脉右支分流术后支架狭窄发生率为35.62%（26/73）,经门静脉左支分流术后支架狭窄发生率为17.65%（9/51）,两者间差异有统计学意义（P=0.029）。结论 Fluency覆膜支架行TIPS术后支架狭窄多发生在支架两端,与分流道位置选择、支架长度、支架成角角度、释放位置等因素相关,高发时间窗为术后6-24个月。选择门静脉左支分流、最合适支架尺寸并精准释放,可降低术后支架狭窄发生率。Objective To investigate the causes of stent stenosis after transjugular intrahepatic portosystemic shunt（TIPS） with Fluency covered stent and to discuss the optimal site for stent implantation in order to improve the clinical efficacy. Methods A total of 124 patients with portal hypertension due to cirrhosis, who were admitted to authors＇ hospital during the period from June 2008 to June 2012 to receive TIPS using Fluency covered stent, were collected. Only one Fluency covered stent was used in each patient,and the diameter of the stent was 8 mm. Regular follow- up check- ups with sonography and multi- slice CT scan were performed at 3 months, 6 months, one year, 2 years, 3 years, 4 years and 5 years after the treatment for all patients. According to the diagnostic criteria of shunt stenosis, the presence or absence of shunt dysfunction and recurrence of portal hypertension was judged, and direct portal venography, balloon dilatation or stent placement was conducted to repair the shunt when necessary. Results Successful TIPS was accomplished in all 124 patients, with the success rate being 100%. After TIPS, both the inner diameter and pressure of portal vein were significantly decreased. During the follow- up period stenosis of the stent occurred in 35 patients（28.23%）, among them the stenosis was located at the end of hepatic vein in 22 and at the end of portal vein in 12, besides, complete occlusion of the stent was seen in one patient. The incidence of stent stenosis in patients receiving TIPS via right branch of portal vein was 35.62%（26/73）, while the incidence of stent stenosis in patients receiving TIPS via left branch of portal vein was 17.65%（9/51）; the difference between the two routes was statistically significant（P =0.029）. Conclusion After TIPS with Fluency covered stent, the stenosis usually occurs at both ends of the stent. The occurrence of stenosis is related to the position of the shunt channel, the length of the stent, the angulation of the stent, the implantation site, e

关 键 词：门静脉高压症 经颈静脉肝内门体分流 Fluency覆膜支架 支架狭窄 

分 类 号：R575[医药卫生—消化系统] R815[医药卫生—内科学]