覆膜支架经颈静脉肝内门体分流术治疗门静脉主干癌栓

目的探讨Fluency覆膜支架经颈静脉肝内门腔分流术(TIPS)治疗门静脉主干癌栓并门静脉高压症的临床应用价值。方法对11例原发性肝癌伴门静脉主干癌栓导致门静脉高压症患者行TIPS术。其中9例为食管胃底静脉曲张合并急性出血,另2例为顽固性腹腔积液。TIPS术中采用Fluency覆膜支架建立肝内门腔分流道。测量支架置入前后的门静脉压力。术后随访1~18个月,分析疗效。结果 11例TIPS术均获成功,共置入21枚覆膜支架,直径8mm支架20枚,7mm支架1枚,支架长度4~8cm。平均门静脉压力由术前(32.00±4.12)mmHg降至(11.82±3.09)mmHg(t=10.76,P0.001)。6例在术后1周出现不同程度肝性脑病,经口服乳果糖等内科处理后症状消失。9例急性出血患者术后出血停止,另2例顽固性腹腔积液患者术后腹腔积液明显减少。随访期间,超声提示支架血流通畅,无复发。9例因多器官衰竭于术后2~14个月死亡[平均(5.67±4.00)个月];另2例分别随访16及18个月仍存活。结论对门静脉主干癌栓并门静脉高压症患者,采用覆膜支架行TIPS术是可行的,可有效控制近期门静脉高压相关症状。

Transjugular intrahepatic portosystemic shunt with covered stents in treatment of main portal vein tumor thrombosis

Objective To evaluate transjugular intrahepatic portosystemic shunt（TIPS）with covered stents for main portal vein tumor thrombus（PVTT）.Methods Eleven hepatocellular carcinoma（HCC）patients with PVTT underwent treatment of TIPS.Nine cases was acute massive upper gastrointestinal bleeding and the other 2cases was refractory ascites.All portosystemic shunts were created with Fluency covered stents.Portal vein pressure was assessed before and after TIPS.The follow-up was done during 1—18months.Results TIPS with covered stents were successfully completed in all patients.Twenty-one Fluency stent grafts（length 4—8cm）including 20 grafts with diameter 8mm and 1graft with diameter 7 mm were implanted.The mean portal vein pressure was reduced from（32.00±4.12）mmHg to（11.82±3.09）mmHg（t=10.76,P〈0.001）after TIPS.Hepatic encephalopathy was found in 6cases and resolved with drug therapy.Gastrointestinal bleeding was stopped in 9patients.Refractory ascites was alleviated in 2patients.During followup,ultrasound showed the patency of blood flow,and no recurrence of symptoms.Death due to multiple organ failure occurred 2—14months（mean[5.67±4.00]months）after TIPS in 9cases.The other 2patients were still alive at the 16-and 18-months follow-up,respectively.Conclusion TIPS with covered stents for PVTT is technically feasible.The shortterm efficacy is favorable.