覆膜支架直径及门静脉分支的选取对TIPS术疗效的影响  

The Effect of Selection with the Covered Stent Diameter and Portal Branch on Postoperative Efficacy of TIPS

作　　者：杨建平[1] 方青波[1] 唐加热克[1] 管圣[1] 戈小虎[1] YANG Jianping;FANG Qingbo;TANG Jiareke(Deparment of Vascular Surgery,Xinjiang Uygurs Autonomous Region Pepole’s Hospital,Urumqi 830001,P.R.China)

机构地区：[1]新疆维吾尔自治区人民医院血管外科,乌鲁木齐830001

出　　处：《临床放射学杂志》2020年第7期1417-1421,共5页Journal of Clinical Radiology

基　　金：乌鲁木齐市科学技术计划项目(编号:Y151310017)。

摘　　要：目的探讨经颈静脉肝内门体分流术(TIPS)术中不同直径覆膜支架及门静脉分支的选取对肝硬化门静脉高压并发消化道出血患者疗效的影响。方法将符合本研究纳入标准的肝硬化门静脉高压并食管胃底静脉曲张破裂出血的126患者,术前利用计算机软件随机化分组,其中10 mm-左支组29例、10 mm-右支组30例、8 mm-左支组33例及8 mm-右支组34例,统计分析4组术后疗效及并发症情况,明确TIPS术中不同直径覆膜支架及门静脉分支的选取对术后疗效的影响。结果10 mm-左、右支组较8 mm左、右支组门静脉压力显著降低(P<0.001),腹腔积液也明显缓解(P=0.035),其中8 mm-右支组的腹腔积液缓解情况最差;8 mm-左支组免于肝性脑病累积发生率明显高于其他3组(P=0.029);分流道累积通畅率8 mm-右支组低于其他3组(P=0.046);而在免于再出血事件、术后3个月肝功能改善、生存率方面,4组之间的差异无统计学意义(P>0.05)。结论(1)TIPS术中采用覆膜支架直径8 mm-门静脉左支是最佳的手术方案;(2)若反复腹腔积液患者,肝性脑病发生的可能性较小,可采用10 mm-左支的方案;(3)尽量避免使用8 mm-右支的手术方案。Objective To investigate the effect of different diameters of stent grafts and portal vein branch selection during TIPS on the curative effect of patients with liver cirrhosis and portal hypertension complicated with gastrointestinal bleeding.Methods From January 2016 to December 2018,126 patients with liver cirrhosis,portal hypertension and esophageal and gastric varices rupture and bleeding who met the inclusion criteria of this study were randomized into groups by computer software before operation.Among them,10 mm-left branch group(29 cases),10 mm-right branch group(30 cases),8 mm-left branch group(33 cases)and 8 mm-right branch group(34 cases),statistically analyze the postoperative curative effect and complications of the four groups,and clarify the differences in TIPS surgery The influence of the diameter of the stent graft and the selection of portal vein branches on the postoperative curative effect.Results The portal pressure in the 10 mm-left and right branch group was significantly lower than that in the 8 mm left and right branch group(P<0.001),and the ascites was also significantly relieved(P=0.035).The 8 mm-right branch group had the worst ascites relief;8 mm-The cumulative incidence of hepatic encephalopathy(HE)in the left branch group was significantly higher than the other three groups(P=0.029);the cumulative patency rate of the shunt was 8 mm-the right branch group was lower than the other three groups(P=0.046);However,there was no statistically significant difference between the four groups in terms of avoiding rebleeding events,improving liver function at 3 months after surgery,and survival rate(P>0.05).Conclusion(1)In TIPS,using a stent graft with a diameter of 8 mm-left portal vein is the best surgical plan;(2)If patients with recurrent ascites,HE is less likely to occur,a 10 mm-left branch can be used;(3)Try to avoid using the 8 mm-right branch on surgical planning.

关 键 词：经颈静脉肝内门体分流术 肝硬化 门静脉高压 支架 

分 类 号：R657.3[医药卫生—外科学]