Viatorr支架行TIPS术治疗门静脉高压性静脉曲张消化道出血效果评估

目的评价应用Viatorr支架行经颈静脉肝内门体分流术(TIPS)术治疗门静脉高压性静脉曲张消化道出血的可行性、安全性和临床效果。方法回顾性分析2015年10月至2018年11月收治的42例肝硬化门静脉高压性静脉曲张消化道出血患者临床资料,所有患者符合TIPS治疗指征,均接受Viatorr支架行TIPS术治疗。术中检测门静脉压力梯度(PPG)。术后1、3、6、12个月,之后每年随访超声或增强CT检查,评价分流道通畅情况,并通过电子病历、临床或电话随访患者肝功能、凝血4项、再出血、肝性脑病发生和生存时间。配对t检验分析术前、术后PPG、总胆红素、血清白蛋白和凝血酶原时间变化,Kaplan-Meier法分析分流道通畅率和生存率。结果 42例均成功施行TIPS术,技术成功率为100%。共植入直径8 mm Viatorr支架42枚。PPG均值由术前(26.85±6.00) mmHg(1 mmHg=0.133 kPa)降低为(11.62±4.54) mmHg(t=11.359,P<0.05),平均降低(55.63±16.77)%。与术前相比,术后3 d总胆红素浓度升高(P<0.05),血清白蛋白降低(P<0.05),凝血酶原时间延长(P<0.05)。术后1个月总胆红素、血清白蛋白和凝血酶原时间与术前水平差异均无统计学意义(P>0.05)。术后中位随访14.5(2~39)个月,再出血发生率为9.5%(4/42),其中1例接受分流道再通;肝性脑病发生率为19.1%(8/42)。术后1、2、3年分流道通畅率分别为91.9%、83.9%、77.4%,生存率分别为94.7%、89.4%、82.0%。肝硬化相关死亡率为9.5%(4/42),均于术后2~30个月死于终末期肝病伴多脏器功能衰竭。结论 Viatorr支架行TIPS术治疗肝硬化门静脉高压性静脉曲张消化道出血具有较高的技术成功率,术后分流道通畅率高,肝性脑病发生率低。

TIPS creation by using Viatorr stent-graft for the treatment of variceal gastrointestinal bleeding due to portal hypertension: evaluation of its clinical efficacy

Objective To evaluate the feasibility, safety and clinical effect of transjugular intrahepatic portosystemic shunt(TIPS) creation by using Viatorr stent-graft in treating variceal bleeding due to portal hypertension. Methods The clinical data of 42 patients with variceal gastrointestinal bleeding due to cirrhotic portal hypertension, who were admitted to the Department of Interventional Radiology of the First Affiliated Hospital of China Medical University during the period from October 2015 to November 2018, were retrospectively analyzed. All patients had indications for TIPS treatment, and TIPS creation by using Viatorr stent-graft was performed in all patients. During TIPS procedure, the portal pressure gradient(PPG) was measured. Follow-up ultrasound or enhanced CT examination was performed at one, 3, 6 and 12 months after TIPS and thereafter it was performed once a year to evaluate the unobstructed condition of shunt. The patients’ liver function, 4 coagulation items, rebleeding, occurrence of hepatic encephalopathy and survival time were followed up by electronic medical record, clinical examination or telephone inquiry. Paired t-test was used to analyze preoperative and postoperative PPG, total bilirubin, serum albumin and prothrombin time, and Kaplan-Meier method was used to assess the patency rate of shunt and the survival rate. Results Successful TIPS procedure was accomplished in all 42 patients, the technical success rate was 100%. A total of 42 Viatorr stents of 8 mm diameter were implanted in 42 patients. The mean PPG value decreased from preoperative(26.85±6.00) mmHg to postoperative(11.62±4.54) mmHg(t=11.359, P<0.05) with an average reduction of(55.63±16.77)%. Compared with preoperative values, three days after TIPS the total bilirubin concentration was significantly increased(P<0.05), the serum albumin was obviously decreased(P<0.05), and the prothrombin time was remarkably prolonged(P<0.05). One month after TIPS, the total bilirubin concentration, the serum albumin and the prothrombin time showed no significant differences from preoperative ones(P>0.05 in all). The median follow-up time was 14.5 months(2-39 months). The incidence of rebleeding was 9.5%(4/42), one patient had to receive shunt recanalization procedure. The incidence of hepatic encephalopathy was 19.1%(8/42). At 1, 2 and 3 years after TIPS, the patency rate of shunt was 91.9%, 83.9% and 77.4% respectively and the survival rate was 94.7%, 89.4% and 82.0% respectively. Cirrhosis-related mortality was 9.5%(4/42), and most patients died of terminal-stage hepatic disease with multiple organ failure within 2-30 months after TIPS. Conclusion For the treatment of gastrointestinal bleeding due to cirrhotic portal hypertension, TIPS creation by using Viatorr stent-graft has some advantages such as higher technical success rate, higher patency rate of shunt and lower incidence of hepatic encephalopathy.