南方医科大学学报2016，Vol.36Issue(10)：1444-1448,5.DOI:10.3969/j.issn.1673-4254.2016.10.26
经颈静脉肝内门腔分流术中覆膜支架两端长度与长期疗效的关系
Effect of covered stent length in portal and hepatic veins on long-term clinical efficacy of transjugular intrahepatic portosystemic shunt
胡朋 1陈斯良 1林志鹏 1赵剑波 1陈勇 1何晓峰 1曾庆乐 1李彦豪1
作者信息
- 1. 南方医科大学南方医院介入科，广东 广州 510515
- 折叠
摘要
Abstract
Objective To evaluate the effect of the length of covered stents in the portal and hepatic veins on long-term clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS). Methods We retrospectively reviewed 53 cases receiving TIPSs between January, 2008 and December, 2011. All the shunts were created with Fluency stents (8 mm in diameter). Bare metal grafts of the same diameter were implanted to extend the length in the portal and hepatic veins as deemed necessary according to angiographic images. The primary patency, hepatic encephalopathy and patient survival were evaluated during the follow up. The length of the covered stents within the hepatic vein (X1) and in the portal vein (X2), and the total length of stents placed in the hepatic vein (X3) and the portal vein (X4) were measured and their effects on primary patency and the patients’outcomes were evaluated. Results The procedures were completed successfully in all the patients and the mean portosystemic pressure decreased from 29.80 ± 4.83 mmHg to 19.00 ± 3.92 mmHg (t=13.44, P<0.01) after the procedure. The patients were followed up for a median of 64 months (3 to 89 months, 39 months on average). Hepatic encephalopathy occurred in 23%(12/53) of the patients after TIPS. Shunt dysfunction occurred in 16 cases, and the cumulative primary patency rates at 1 to 5 years were 83%, 75%, 63%, 62%, and 54%, respectively. The cumulative survival rates of the patients at 1 to 5 years were 79%, 72%, 72%, 69%, and 69%, respectively. Cox proportional regression analysis showed a significant association between the length of covered-stent in the hepatic vein and the primary patency (OR=0.42, P<0.01), and there was a significant association between the length of stent in the portal vein and the patient survival. No significant correlation was found between these parameters and hepatic encephalopathy. Conclusion Increasing the length of the covered stent in the hepatic vein and decreasing the stent length in the portal vein can improve the primary patency and the patient survival receiving TIPS.关键词
经颈静脉肝内门腔分流术/覆膜支架/裸支架Key words
transjugular intrahepatic portosystemic shunt/covered stents/bare stents引用本文复制引用
胡朋,陈斯良,林志鹏,赵剑波,陈勇,何晓峰,曾庆乐,李彦豪..经颈静脉肝内门腔分流术中覆膜支架两端长度与长期疗效的关系[J].南方医科大学学报,2016,36(10):1444-1448,5.
