门静脉高压症经颈静脉肝内门体分流术后覆膜支架分流道再狭窄率及原因分析

目的探讨采用聚四氟乙烯（PTFE）覆膜支架行经颈静脉肝内门体分流术（TIPS）术后覆膜支架分流道再狭窄及相关影响因素。方法回顾性分析82例门静脉高压症患者的临床资料，术前肝功能Child-Pugh评分（6．74±1．05）分，均采用PTFE覆膜支架行TIPS，术后随访12～55（24．9±10．4）个月，观察术后再狭窄率并对相关影响因素进行Cox单因素和多因素回归分析。结果全部82例患者均在局部麻醉下成功建立肝内门体覆膜支架分流道。门静脉．右房压力梯度由术前（27．46±4．08）mmHg（1mmHg=0．133kPa）下降为术后（15．71±2．07）mmHg，差异有统计学意义（P〈0．01）。术后3个月肝功能Child—Pugh评分（6．57±1．43）分，与术前比较差异无统计学意义（P〉0．05）。随访期间确诊出现覆膜支架分流道再狭窄8例，一期再狭窄率为9．8％（8／82）。Cox单因素回归分析提示覆膜支架进入门静脉长度≤1．0cm和覆膜支架肝静脉端位置评价良好差异有统计学意义（P〈0．01）；多因素回归分析提示只有后者为独立影响因素（OR=26．647，95％CI：8．257～20．061，P=0．005）。结论PTFE覆膜支架可以明显提高TIPS术后分流道通畅率，覆膜支架肝静脉端位置良好的患者术后分流道再狭窄发生率低，同时不建议覆膜支架门静脉端伸入过长。

Postoperative shunt restenosis of transjugular intrahepatic portasystemic shunt using covered stent in patients with portal hypertension and analysis of its influencing factors

Objective To evaluate the postoperative shunt restenosis of transjugular intrahepatic portasystemic shunt （TIPS） using polytetrafluoroethyoethylene （PTFE） covered stent in patients with portal hypertension,and discuss its influencing factors. Methods The clinical data of 82 patients with portal hypertension were retrospectively analyzed. TIPS with PTFE covered stent was carried out in all patients, and the preoperative Child-Pugh score was （6.74 ±1.05） scores. The patients were followed up for 12 -55 （24.9 ±10.4） months. Single and multiple factor analysis using Cox regression were performed to evaluate the influencing factors. Results Under the local anaesthesia,TIPS was successful performed in all 82 patients. The portosystemic pressure gradient decreased from preoperative （27.46±4.08） mmHg （1 mmHg =0.133 kPa） to postoperative （15.71±2.07） mmHg,and the difference was statistically significant （t = 1.804,P 〈 0.01 ）. The Child-Pugh score 3 months after operation was （6.57±1.43 ） scores, and there was no statistical difference compared with that before treatment （t = 12.931 ,P 〉 0.05 ）. During the follow-up period, shunt restenosis of covered stent occurred in 8 patients, and the rate of restenosis was 9.8% （8/82）. Cox single analysis showed that the covered stent length within portal vein 1.0 cm and its location inhepatic vein had statistical significance, and multiple factor regression analysis showed that the covered stent location in hepatic vein was the independent influencing factor of shunt restenosis （OR = 26.647,95% CI： 8.257 - 20.061,P = 0.005）. Conclusions TIPS with PTFE covered stent can markedly increase the shunt patency rate. A proper location of the covered stent within hepatic vein carries lower restenosis incidence. Hyperextension of the stent into portal vein is not recommended.