覆膜支架TIPS术中门静脉穿刺位置对术后长期疗效的影响  

Influence of puncture sites of portal vein in TIPS with PTFE-covered stent on long-term clinical efficacy

作　　者：陈斯良 赵剑波[1] 陈勇[1] 何晓峰[1] 曾庆乐[1] 叶鹏[1] 罗泽龙[1] 胡朋[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9期530-534,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：2012年广东省科技计划项目(2012B010200027);2013年广州市科技计划项目(201300000199)

摘　　要：目的 探讨经颈静脉肝内门腔静脉分流术（TIPS）中门静脉穿刺位置对术后长期疗效的影响。方法 回顾性分析采用覆膜支架完成TIPS手术的171例患者。根据术中门静脉穿刺位置分为门静脉主干或分叉部（A组,n=88）、门静脉右支（B组,n=48）及门静脉左支（C组,n=35）。使用Kaplan-Meier分析曲线及Log-rank检验分析术后分流道通畅率、肝性脑病（HE）发生率及生存率。结果171例患者均成功建立门腔分流道,术后随访3~94个月,平均（35.23±18.91）个月;分流道狭窄率为29.82%（51/171）;HE发生率为31.58%（54/171）;死亡率为19.30%（33/171）。组间比较：（1）分流道狭窄率,C组与A组、B组的差异均有统计学意义（χ~2=11.49,P=0.001;χ~2=4.54,P=0.033）,A组与B组的差异亦有统计学意义（χ~2=4.12,P=0.046）;（2）HE发生率,C组与A组、B组的差异均有统计学意义（χ~2=8.07,P=0.004;χ~2=9.44,P=0.002）。3组术后死亡率差异无统计学意义（χ~2=0.364,P=0.834）。结论 TIPS术中选择门静脉左支建立门腔分流道,术后长期再狭窄率及HE发生率均较低。Objective To evaluate the influence of puncture sites of portal vein in transjugular intrahepatic portosystemic shunt （TIPS） on long-terra clinical efficacy. Methods A retrospective review including 171 patients underwent TIPS with Fluency PTFE-covered stent was performed. All the cases were divided into 3 groups： intersection or trunk of portal vein （group A, n=88）, right branch of portal vein （group B, n=48） and left branch of portal vein （group C, n=35）, accord- ing to the puncture site of TIPS. Kaplan-Meier analysis with Log-rank test were performed to assess the effect of different puncture sites on primary patency, hepatic encephalopathy （HE） and survival. Results The procedures were successful in 171 patients. All the cases were followed up for 3 to 94 months with the average of （35.23±18.91） months. The primary restenosis rate was 29.82% （51/171）, the cumulative HE rate was 31.58% （54/171） and the cumulative death rate was 19.30% （33/171）. The group C versus group A, group C versus group B and group A versus group B were statistically significant on primaryrestenosis （x2=11.49, P=0.001; x2=4.54, P=0.033; x2=4.12, P=0.046）. The groupCver- sus group A and group C versus group B were statistically significant on cumulative HE rate （x2= 8.07, P= 0. 004; x2= 9.44, P=0. 002）. There was no significant difference on survival （X2 = 0. 364, P= 0. 834）. Conclusion Choose the left branch of portal vein as the puncture site to create the shunt in TIPS can decrease the incident of primary restenosis and HE significantly.

关 键 词：高血压 门静脉 门体分流术 经颈静脉肝内 门静脉穿刺位置 临床疗效 

分 类 号：R575.2[医药卫生—消化系统]