采用裸支架联合覆膜支架建立经颈静脉肝内门体分流术的中远期疗效  

Medium-long efficacy in transjugular intrahepatic portalsystemic shunts utilizing bare and covered stent

作　　者：胡朋[1] 陈斯良 罗泽龙[1] 赵剑波[1] 陈勇[1] 何晓峰[1] 曾庆乐[1] 叶鹏[1] 李彦豪[1] 

机构地区：[1]南方医科大学南方医院介入科,广东广州510515

出　　处：《中国介入影像与治疗学》2016年第7期394-397,共4页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的 探讨经颈静脉肝内门体分流术（TIPS）中采用裸支架联合覆膜支架建立分流道的中远期疗效。方法回顾性分析我院连续71例采用裸支架＋覆膜支架方式建立TIPS分流道的患者资料。术中均采用8mm直径支架建立分流道,首先置入相应长度裸支架,再于其内置入同等直径覆膜支架,覆膜支架长度小于裸支架2cm,使分流道远心端门静脉内2cm为裸区,近心端裸支架与覆膜支架平齐达下腔静脉开口部。分析术后分流道通畅率、肝性脑病发生率及生存率。结果 对所有患者均成功建立肝内分流道。术前、术后门静脉压力分别为（3.67±0.82）kPa、（2.31±0.62）kPa（P〈0.01）。随访2-63个月,平均（25.83±11.34）个月;共置入裸支架76枚,覆膜支架73枚;术后1、2、3年的分流道通畅率为87%、72%、61%,肝性脑病发生率为16%、34%、46%,生存率为83%、74%、67%。结论 采用裸支架联合覆膜支架方式建立TIPS分流道的中远期疗效与TIPS专用覆膜支架近似,可作为必要时的替代产品。Objective To investigate the medium-long efficacy of shunt in transjugular intrahepatic portalsystemic shunts （TIPS） utilizing bare and covered stents. Methods Seventy-one patients who underwent TIPS using bare and covered stents were retrospectively analyzed. All the patients＇ shunt were created by 8 mm stents in diameter. The suitable length of bare stents were implanted, and inside the same diameter covered stents was implanted. The covered stent was 2 cm shorter than the bare stent, and at the portal vein end of the shunt 2 cm was bare area, the liver vein end of the shunt was just entering the inferior vena cava. The patency rate, hepatic encephalopathy rate and survival rate after TIPS were analyzed. Results Shunts were created in all the patients. Portal venous pressure decreased from （3.67±0.82）kPa to （2.31±0.62）kPa after TIPS （P〈0.01）. Follow-up time was 2-63 months （mean [25.83±11.34] months）. All of 76 bare stents and 73 covered stents were implanted. The patency rate of 1 year, 2 years and 3 years was 87%, 72% and 61%, the hepatic encephalopathy rate was 16%, 34%, 46%, and the survival rate was 83%, 74%, 67%. Conclusion Bare stent combined with covered stent to creat TIPS shunt has an approximate efficacy compared to the TIPS special covered stent, so it could be used if necessary.

关 键 词：高血压 门静脉 经颈静脉肝内门腔分流术 支架 治疗效果 放射学 介入性 

分 类 号：R575.2[医药卫生—消化系统]