8 mm与10 mm直径覆膜支架在治疗肝硬化合并难治性腹水患者中临床效果比较研究  

Comparison of the clinical efficacy of 8 mm and 10 mm covered stents in patients with cirrhosis and refractory ascites

作　　者：汪博 汪檬檬 祝叶静 陈沐桦 李惠晨 朱军 赵首捷 杜锡林 刘雷 WANG Bo;WANG Meng-meng;ZHU Ye-jing;CHEN Mu-hua;LI Hui-chen;ZHU Jun;ZHAO Shou-jie;DU Xi-lin;LIU Lei(State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers,National Clinical Research Center for Digestive Diseases,Xijing Hospital of Air Force Medical University,Xi′an 710032,China;Department of General Surgery,Second Affiliated Hospital of Air Force Medical University,Xi′an 710038,China;Department of Drug and Equipment,Lintong Rehabilitation and Convalescent Centre,Xi′an 710600,China;Department of Biochemistry and Molecular Biology School of Basic Medicine,Air Force Medical University,Xi′an 710032,China;Department of General Surgery,Air Force Hospital of Southern Theater Command,Guangzhou 510030,China)

机构地区：[1]空军军医大学西京医院消化病医院、国家消化系统疾病临床医学研究中心消化系肿瘤整合防治全国重点实验室,陕西西安710032 [2]空军军医大学第二附属医院普通外科,陕西西安710038 [3]联勤保障部队临潼康复疗养中心药剂科,陕西西安710600 [4]空军军医大学基础医学院生物化学与分子生物学教研室,陕西西安710032 [5]南部战区空军医院普通外科,广东广州510030

出　　处：《临床军医杂志》2024年第11期1119-1122,1128,共5页Clinical Journal of Medical Officers

基　　金：陕西省自然科学基金(2024JC-JCQN-78)。

摘　　要：目的比较在经颈静脉肝内门体静脉分流术(TIPS)中使用8 mm与10 mm直径的覆膜支架对肝硬化合并难治性腹水(RA)患者的临床效果。方法选取自2011年1月至2018年9月于我国11个中心接受TIPS治疗的332例肝硬化合并RA患者为研究对象。根据支架直径将患者分为8 mm支架组(n=177)与10 mm支架组(n=155)。比较两组患者肝门静脉压力梯度及临床结局。采用单因素和多因素Cox比例风险模型分析术后穿刺需求的独立影响因素。结果两组术前及术后肝门静脉压力梯度比较,差异均无统计学意义(P>0.05)。8 mm支架组穿刺需求累积发生率高于10 mm支架组,差异有统计学意义(P<0.05)。两组患者肝性脑病、肝性脑病等级>1级、静脉曲张出血、自发性细菌性腹膜炎、肝细胞癌、支架功能障碍、肝移植、死亡发生情况比较,差异无统计学意义(P>0.05)。支架直径、年龄是术后穿刺需求的独立影响因素(P<0.05)。结论与8 mm支架比较,10 mm的聚四氟乙烯覆膜支架能够更好地控制RA患者腹水再发,且未增加肝性脑病的发病率。Objective To compare the clinical efficacy of transjugular intrahepatic portosystemic shunt(TIPS)creation performed by using an 8 mm or a 10 mm diameter polytetrafluoroethylene(PTFE)covered stent in a consecutive series of patients with cirrhosis and refractory ascites(RA).Methods A total of 332 patients with cirrhosis complicated with RA who received TIPS from 11 centers in China from January 2011 to September 2018 were selected as the study subjects.Patients were divided into 8 mm stent group(n=177)and 10 mm stent group(n=155)according to stent diameter.Hepatic portal vein pressure gradient and clinical outcome were compared between the two groups.Univariate and multivariate Cox proportional risk models were used to analyze the independent influencing factors of postoperative puncture demand.Results There was no significant difference in preoperative and postoperative hepatic portal vein pressure gradient between the two groups(P>0.05).The cumulative incidence of puncture in the 8 mm stent group was higher than that in the 10 mm stent group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of hepatic encephalopathy,hepatic encephalopathy grade>1,varicose hemorrhage,spontaneous bacterial peritonitis,hepatocellular carcinoma,scaffold dysfunction,liver transplantation and death between two groups(P>0.05).Stent diameter and age were independent influencing factors for postoperative puncture requirements(P<0.05).Conclusion Compared with the 8 mm stent,the 10 mm PTFE coated stent can better control the recurrence of ascites in RA patients,and does not increase the incidence of hepatic encephalopathy.

关 键 词：肝硬化 经颈静脉肝内门体静脉分流术 难治性腹水 肝性脑病 覆膜支架 

分 类 号：R575.2[医药卫生—消化系统]