覆膜支架直径的选取对肝硬化门脉高压患者经颈静脉肝内门体静脉分流术后疗效的影响  

Influence of the covered stent diameter′s selection on postoperative efficacy of transjugular intrahepatic portosystemic shunt in patients with portal hypertension with liver cirrhosis

作　　者：唐加热克[1] 杨建平[1] 管圣[1] 朱兵[1] 慈红波[1] 戈小虎[1] Tang Jiareke;Yang Jianping;Guan Sheng;Zhu Bing;Ci Hongbo;Ge Xiaohu(Deparment of Vascular Surgery,People′s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,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：《国际外科学杂志》2020年第12期800-804,F0003,共6页International Journal of Surgery

基　　金：乌鲁木齐市科学技术计划项目(Y151310017)。

摘　　要：目的探讨经颈静脉肝内门体静脉分流术(TIPS)中覆膜支架直径的选取对肝硬化门脉高压患者术后疗效的影响。方法回顾性分析2016年1月—2018年12月新疆维吾尔自治区人民医院收治的126例肝硬化门静脉高压并食管胃底静脉曲张破裂出血患者的病例资料,根据TIPS术中使用支架直径不同将其分为两组:10 mm组(n=59)和8 mm(n=67)组。10 mm组患者在TIPS术中采用直径为10 mm的覆膜支架,8 mm组患者在TIPS术中采用直径为8 mm的覆膜支架。评估10 mm组和8 mm组患者的术后门静脉压力下降情况、腹水变化、肝功能改善、肝性脑病发病率、再出血发生率及分流道失功情况,明确TIPS术中覆膜支架直径的选取对术后疗效的影响。计量资料以均数±标准差(Mean±SD)表示,组间比较采用单因素方差分析或独立样本t检验;计数资料组间比较采用χ2检验或非参数秩和检验。术后疗效和并发症影响因素分析采用Kaplan-Meier法。结果10 mm组和8 mm组患者的术后门静脉压力、门静脉压力降低值、免于肝性脑病的累积发生率、术后3个月腹水缓解情况比较,差异均具有统计学意义(P<0.001、<0.001、0.029、0.007)。但是10 mm组和8 mm组患者的分流道通畅率、免于再出血事件、肝功能改善、生存率比较,差异均无统计学意义(P=0.356、0.978、0.137)。结论对于肝功能储备较好合并大量腹水者,10 mm方案可能取得一个良好的治疗效果;TIPS中8 mm覆膜支架的方案具有良好的临床效果,保持与10 mm方案相同的分流道通畅率,而肝性脑病风险降低一半多,相比而言是最为理想的手术方案。Objective To investigate the influence of the diameter of covered stent in transjugular intrahepatic portosystemic shunt(TIPS)on the postoperative efficacy of cirrhotic patients with portal hypertension.Methods From January 2016 to December 2018,126 patients with portal hypertension complicated with esophageal and gastric varices bleeding in People′s Hospital of Xinjiang Uygur Autonomous Region were reviewed.According to the stent diameter in TIPS,they were divided into two groups:10 mm group(n=59)and 8 mm(n=67)group.The diameter of covered stent in TIPS was 10 mm in the 10 mm group and 8 mm in the 8 mm group.The portal vein pressure reduction,ascites change,liver function improvement,incidence of hepatic encephalopathy,rebleeding rate and shunt dysfunction in 10 mm group and 8 mm group were evaluated,and the influence of the diameter of covered stent on postoperative efficacy was determined.The measurement data were expressed as Mean±SD,and the comparison between groups was conducted by one-way ANOVA or independent sample t-test;the comparison of count data between groups was conducted by Chi-square test or nonparametric rank sum test.Kaplan-Meier method was used to analyze the postoperative efficacy and influencing factors of complications.Results There were statistically significant differences in portal vein pressure,portal vein pressure reduction,cumulative incidence of hepatic encephalopathy,and ascites remission at 3 months after operation between 10 mm group and 8 mm group were statistically significant(P<0.001,<0.001,0.029,0.007).However,there were no significant differences in the patency rate,no rebleeding events,improvement of liver function and survival rate between the 10 mm group and the 8 mm group(P=0.356,0.978,0.137).Conclusion For patients with good liver function reserve and a large amount of ascites,the 10 mm protocol may achieve a good therapeutic effect;the 8 mm covered stent in TIPS has good clinical effect,maintaining the same shunt patency rate as the 10 mm scheme,and reducing the risk

关 键 词：经颈静脉肝内门体分流术 消化道出血 门静脉高压症 肝硬化 食管胃底静脉曲张 疗效比较研究 

分 类 号：R657.3[医药卫生—外科学]