裸金属支架与PTFE-覆膜支架行TIPSS治疗门静脉高压症患者临床疗效对比研究

目的 使用裸金属支架（BMS）和聚四氟乙烯（PTFE）覆膜支架行经颈静脉肝内门腔静脉支架分流术（TIPSS）治疗门静脉高压症患者临床疗效和技术设备成本对比分析。方法 2010年5月～2015年6月对163例门静脉高压症患者行TIPSS术，患者平均年龄为（56±12） 岁，女性占32.9 %。其中接受BMS支架80例，接受覆膜支架83例。结果 本组技术成功率为97.5%，术后门体梯度压从（16.1±4.8） mmHg下降至（5.1±2.1） mmHg；两组技术成功率和门体梯度压降无显著性差异；Kaplan-Meier分析显示，两组14 d、6 m和2 a一期支架通畅率存在显著性差别，其中PTFE-覆膜支架组通畅率高；两组1 a生存率和肝性脑病发生率无显著性差异；金属支架和覆膜支架总成本分别为66570元和70455元。结论 TIPSS术是一种安全、有效的治疗门静脉高压症的方法。裸金属支架和PTFE-覆膜支架均具有良好的技术和临床效果，并发症发生率低。

Comparison of technical and clinical efficacy of bare metal stent and PTFE-stentgraft of TIPSS in the treatment of patients with portal hypertension

Objective To compare the technical and clinical efficacy of bare metal stent（BMS） and polytetrafluoroethylene（PTFE）-stentgraft of transjugular intrahepatic portosystemic shunt（TIPSS） in treatment of patients with portal hypertension（PH）.Methods 163 patients（56±12 ys，32.9 % females） with PH receiving TIPSS were recuited in this study，and 80 patients received BMS and 83 received PTFE-stentgraft.Results The technical success rate was 97.5% due to four unsuccessful interventions. The portosystemic gradient decreased from （16.1±4.8） mmHg to（5.1±2.1） mmHg in the successful series. There was no significant differences as respect to technical success rate and portosystemic gradient decrease between the two groups；Kaplan-Meier analysis yielded significant differences in primary patency after 14 days，6 months and 2 years thereafter in favour of the stentgraft；Both groups showed good clinical results without significant difference in 1-year survival and hepatic encephalopathy occurrence；Costs to establish TIPSS and maintain 2-year follow-up for constant patency were 66570 yuan in BMS group and 70455 yuan in PTFE-stentgraft.Conclusion TIPSS is a safe and effective procedure to manage portal hypertension. Both BMS stent and PTFE-stentgraft enable good technical and clinical outcomes with low complication rate，while the primary patency rate is clearly in favour of the stentgraft with a relative high costs.