采用Viatorr支架行TIPS治疗肝硬化食管胃静脉曲张出血的中远期疗效分析  

Analysis of the medium-long-term efficacy of TIPS with Viatorr stent in treating esophagogastric variceal bleeding in liver cirrhosis

作　　者：杨鑫铖 陈雷[1] 张学强[1] 徐梦辉[1] 秘建威 王霄云 路敏 冯志杰[1] 靳晓旭 YANG Xincheng;CHEN Lei;ZHANG Xueqiang;XU Menghui;BI Jianwei;WANG Xiaoyun;LU Min;FENG Zhijie;JIN Xiaoxu(Department of Gastroenterology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院消化内科,河北石家庄050000

出　　处：《实用放射学杂志》2023年第2期295-298,共4页Journal of Practical Radiology

基　　金：河北省重点研发计划项目(20377798D)。

摘　　要：目的探讨采用Viatorr支架行经颈静脉肝内门体分流术(TIPS)治疗肝硬化食管胃静脉曲张出血的中远期疗效与预后。方法回顾性分析因肝硬化食管胃静脉曲张出血行TIPS的45例患者资料,术中均采用Viatorr支架建立分流道,于术中常规测量门静脉压力梯度(PVPG),术后1周及1、3、6、12、24个月复查门静脉超声观察支架通畅情况,并了解患者有无消化道出血、肝性脑病以及生存情况等。应用配对t检验和Kaplan-Meier曲线进行统计学分析。结果45例患者TIPS手术成功率100%。分流后PVPG较分流前明显下降[(10.91±4.38)mmHg vs(24.14±7.40)mmHg,t=11.88,P<0.001]。随访期间有4例患者分别于术后1、6、15、24个月再次发生食管胃静脉曲张出血,术后12、24个月累积再出血率分别为4.4%、8.9%。术后死亡患者3例,术后12、24个月累积生存率均为93.3%。12例患者出现肝性脑病,术后3、6、12、24个月累积发病率分别为15.6%、17.8%、20%、26.7%。2例患者在术后1周出现支架功能障碍,术后24个月累积发生率为4.4%。结论肝硬化食管胃静脉曲张患者行TIPS可显著降低PVPG,采用Viatorr支架行TIPS术后再出血、支架功能障碍及肝性脑病发生率均较低,累积生存率较高,具有良好的中远期疗效。Objective To investigate the medium-long-term efficacy and prognosis of transjugular intrahepatic portosystemic shunt(TIPS)with Viatorr stent in treating esophagogastric variceal bleeding in liver cirrhosis.Methods A retrospective analysis was performed on 45 patients who received TIPS treatment for esophagogastric variceal bleeding due to liver cirrhosis.Viatorr stent was used to establish shunt channels during the TIPS procedure.The portal venous pressure gradient(PVPG)was routinely measured intraoperatively,and the patency of the stent in portal vein was observed using ultrasound at 1 week,1,3,6,12 and 24 months after the operation.During the follow-up period,the gastrointestinal bleeding,hepatic encephalopathy and survival in enrolled patients were monitored.Paired t test and Kaplan-Meier curve were used for statistical analysis.Results The success rate of TIPS was 100%in 45 patients.The PVPG decreased significantly after the operation compared with before the operation[(10.91±4.38)mmHg vs(24.14±7.40)mmHg,t=11.88,P<0.001].During the follow-up period,4 patients had recurrente esophagogastric variceal bleeding at 1,6,15,and 24 months after the operation,respectively.The cumulative rebleeding rates at 12 and 24 months after the operation were 4.4%and 8.9%,respectively.Three patients died after the operation,and the cumulative survival rates at 12 and 24 months after the operation were both 93.3%.Hepatic encephalopathy occurred in 12 patients,and the cumulative incidence at 3,6,12,and 24 months after the operation was 15.6%,17.8%,20%,and 26.7%,respectively.Stent dysfunction occurred in 2 of the 45 patients during the first week after the operation,with a cumulative incidence of 4.4%at 24 months after the operation.Conclusion TIPS can significantly reduce the PVPG,and the application of Viatorr stent in TIPS may result in lower incidence of rebleeding,stent dysfunction and hepatic encephalopathy,and a higher cumulative survival rate and good medium-long-term efficacy in patients with liver cirrhosis and esophago

关 键 词：经颈静脉门体分流术 Viatorr支架 肝硬化 门静脉高压 食管胃静脉曲张出血 

分 类 号：R815[医药卫生—放射医学] R657.31[医药卫生—临床医学] R543.6