经颈静脉肝内门体分流术中覆膜支架与非覆膜支架效果的比较

目的 对比覆膜与非覆膜支架在TIPS中应用的临床疗效.方法 回顾性研究30例临床诊断为肝硬化接受TIPS治疗(按照术后是否有覆膜支架分为覆膜支架组20例、非覆膜支架组10例)的患者的临床资料.本组患者手术前后测量门静脉压力,术后彩色超声观察分流道通畅情况.采用四格表资料的Fisher确切概率法进行两组间病死率、再出血率及肝性脑病发生率等临床指标对比.结果 30例患者手术均成功,门静脉压力在覆膜组由术前(3.78±0.50)kPa降至术后(2.21±0.44)kPa,非覆膜组由术前(3.67±0.48)kPa降至术后(2.13±0.35)kPa.术后随访资料完整的26例(覆膜支架组17例,非覆膜支架组9例),随访时间为7 d～62个月(中位随访时间23个月).随访期内死亡13例,覆膜支架组8例、非覆膜支架组5例,两组差异无统计学意义(P>0.05),均死于上消化道出血及肝功能衰竭.覆膜组再出血5例、非覆膜组3例,两组差异无统计学意义(P>0.05).发生肝性脑病在覆膜支架组4例、非覆膜支架组2例,两组差异无统计学意义(P>0.05).术后6个月和1年分流道通畅率在覆膜支架组均为100.0%,非覆膜支架组分别为77.8%(7/9)和55.6%(5/9),两组差异有统计学意义(P<0.05).结论 覆膜支架组1年分流道通畅率优于非覆膜支架,但两组病死率、再出血率及肝性脑病发生率差异无统计学意义.

A comparison of clinical efficacy between covered stent-grafts and bare stents in transjuglar in-trahepatic portosystemic shunt

Objective To compare the clinical efficacy between covered stent and uncovered stent in transjuglar in-trahepatic portosystemic shunt (TIPS) .Methods Thirty patients with liver cirrhosis (portal hypertension), who received TIPS, were retrospectively studied.All patients were divided into two groups covered-stent group(n =20) and uncovered-stent group (n=10).For each patient, portal pressure was measured before and after operation, and the patency of shunt was evaluated by color Doppler ultrasound after operation.The mortality, recurrent bleeding rate and incidence of hepatic encephalopathy were analyzed by Fisher exact probability test.Results The TIPS treatment was successful in all patients, the portal pressure in the covered-stent group reduced from (3.78±0.50) kPa before operation to (2.21±0.44) kPa and that of the uncovered-stent group reduced from (3.67±0.48) kPa to (2.13±0.35) kPa.Twenty-six cases were postoperatively followed-up (17 cases in covered-stent group, 9 cases in uncovered-stent group).The follow-up period varied from 7 days to 62 months (median follow-up period was 23 months).Thirteen patients died of upper gastrointestinal bleeding and hepatic failure.The difference of mortality between covered-stent group (8/17) and uncovered-stent group (5/9) did not reach significant (P>0.05).The recurrent bleeding rate between the covered-stent group (5/17) and the uncovered-stent group (3/9) was not different too (P>0.05).The incidence of hepatic encephalopathy in the covered-stent group (4/17) was not different from that of the uncovered-stent group (2/9) (P> 0.05).The patency rates of 6 months and 12 months reached 100% in the covered-stent group, which were higher than those in the uncovered- stent group 77.8% (7/9) and 55.6% (5/9) (P<0.05) .Conclusions The patency rate of shunt at 12 months after TIPS was higher in the covered-stent group than the uncovered-stent group, while the mortality, recurrent bleeding rate and incidence of hepatic encephalopathy were not significantly different between the two groups.