覆膜支架在经颈静脉门腔分流术中的应用

目的 评价经颈静脉肝内门腔分流术(TIPS)专用覆膜支架(Viatorr支架)在TIPS中的应用价值.方法 回顾性分析37例在美国俄勒冈州健康生命科技大学Dotter介入放射学研究所采用Viatorr支架行TIPS治疗的患者资料,随访时间为(15.2±9.3)个月(3-42个月).TIPS指征包括门静脉高压相关性的急慢性消化道出血,经药物及内镜治疗无效者17例;顽固性肝源性胸、腹水18例,Budd-Chiari综合征2例.采用配对t检验比较手术前后门腔静脉压力差(PSG)的变化,以Kaplan-Meier曲线分析支架开通率.结果 37例共置入41枚Viatorr支架,其中3枚直径为8 mm,38枚为10 mm,支架带膜长度为4～8 cm,无相关手术并发症.PSG由术前的(22.4±8.4)mm Hg(1 mm Hg=0.133 kPa)降为(8.1±3.2)mm Hg,差异有统计学意义(t=12.754,P<0.01).17例出血患者术后出血均停止,1例于术后17个月复发.18例严重顽固性腹水及肝性胸水患者中,4例术后腹水不消退,其余14例随访期间有2例腹水复发.2例(5.4%)发生分流道阻塞,Kaplan-Meier曲线分析结果显示1年的开通率为97.0%.术后1个月内无病死患者,2例分别于术后3个月及15个月死于多器官功能衰竭,晚期病死率为5.4%,死亡前1周内复查支架均通畅.肝移植患者5例(13.5%).结论 Viatorr支架能明显提高TIPS术后开通率,选择合适的支架,采用正确的释放技术能进一步提高疗效,但长期效果评价尚需验证.

Stent-grafts in transjugular intrahepatic portosystemic shunts

Objective To retrospectively evaluate the efficacy of polytetrafluorothylene covered nitinol stent graft (Viatorr, Gore, Flagstaff Arizona, USA) in transjugular intrahepatic partosystemic shunt (TIPS). Methods Thirty-sevan consecutive patients underwent a TIPS procedure between May 2004 and June 2006 at the Dotter Interventionsl Institute in Portland, Oregon, USA. The average follow-up time was (15.2±9.3)months. Indications for the procedure included recurrent varieeal bleeding after attempted endoscopic management (n=17), refractory ascites or hydrothorax ( n = 18 ), and Budd-Chiari syndrome (n = 2). The t test was used for statistics. Results Forty-one stent-grafts were implanted in 37 patients, 3 of the devices were 8 mm in diameter and 38 were 10 mm. The covered stent length varied from 4 to 8 cm without complications. Portosystemic gradient (PSG) decresed significantly from (22.4±8.4) mm Hg (1 nun Hg=0.133 kPa) to(8.1±3.2)mm Hg, (t = 12.754,P <0.01). During the follow-up period, Variceal bleeding recurrence occurred in 1 of 17 patients and for ascites or hydrothorax, two of 14 patients. Shunt occlusion occurred in 2 of 37 (5.4%) patients (4 and 17 months post-shunt). The 1-year primary patency rate was 97.0%. Two patients died from multisystem organ failure (MSOF) with a patent stent-graft during the follow-up period. Five patients were excluded from the evaluation after liver transplantation. Conclusion TIPS created with a PTFE-covered stent (Viatorr) showed favorable patency rate and low complication rates.