TIPS术后支架再狭窄或闭塞的介入治疗

目的 总结经颈静脉肝内门体分流术（ transjugular intrahepatic portosystemic shunt,TIPS）术后支架再狭窄或闭塞的介入治疗.方法 选取2009年1月至2011年12月期间首都医科大学附属北京世纪坛医院介入病房收治的20例TIPS术后支架再狭窄或闭塞的患者,男性15例,女性5例,患者年龄27~58岁,平均年龄48岁.术前门静脉多普勒超声检查及术中数字减影血管造影（digital subtraction angiography,DSA）证实支架再狭窄的患者12例、支架闭塞的患者8例,20例患者所用均为裸支架.经单纯球囊扩张治疗的4例,球囊扩张后再次置入支架治疗的11例,再次穿刺行TIPS再建分流道治疗的5例.结果 术前平均门静脉压力由（3.94±0.52）kPa降至术后的（2.55±0.46）kPa（P〈0.05）,术后1周内3例出现肝性脑病药物治疗后好转,术后口服华法林抗凝治疗,随访1.5年超声检查未见支架再狭窄或闭塞发生.结论 TIPS术后支架存在一定再狭窄或闭塞率,应用介入技术可以再次降低门静脉压力延长患者生存期具有极高的临床应用价值.

Interventional treatment of stent restenosis or occlusion after transjugular intrahepatic portosystemic shunt

Objective To summarize the interventional treatment strategy of stent restenosis or occlusion after transjugular intrahepatic portosystemic shunt (TIPS). Methods The data collected from 20 patients (10 males and 5 females, aged 27-58 years, averaged 48 years) with stent restenosis or occlusion after TIPS from Jan.2009 to Dec.2011 were retrospectively analyzed. 12 patients with stent restenosis and 8 patients with stent occlusion were confirmed by ultrasonography before surgery and intraoperative DSA. All patients were used bare metal stent. 4 patients were performed ballon dilation,11 patients were re-stented after ballon dilation, and 5 patients accepted the second Tips to reconstruct the shut. Results Free portal pressure (FPP) was reduced from(3.94±0.52)kPa to(2.55±0.46)kPa (P<0.05), 3 patients with hepatic coma improved after drug treatment within one week postoperatively. All patients underwent warfarin anticoagulation after intervention. There was no stent restenosis or occlusion during follow-up of 1.5 years. Conclusion The shunt stent has a certain rate of restenosis or occlusion after TIPS, but the prior stent can be expended and the shunt can be reconstructed with interventional techniques, it has the extremely application value in reducing portal pressure and extending the survival of patients.