不同直径PTFE覆膜支架在门脉高压TIPSS术中的应用效果

目的 分析10mm与8mm直径的PTFE覆膜支架在TIPSS术中的应用效果.方法 收集46例行TIPSS术治疗肝硬化门脉高压患者的临床资料,按照支架直径分为10mm组与较小直径8mm组.所有患者于术后1周测定门静脉压力、分流道的初次开通比率,于术后3个月、6个月、9个月和12个月分别复查分流道狭窄率以及肝性脑病的发生率.结果 两组患者的TIPSS手术成功率均为100％,两组患者分流道的初次开通比率为100％,术后门静脉压力分别为（22.4±3.5） cmH2O、（23.2±3.7） cmH2O,均显著低于术前,但两组患者术后差异无统计学意义;空腹血氨水平分别为（41.3±11.39）μg/L、（42.4±11.78）μg/L,比术前水平略有提高,但术后两组患者间差异无统计学意义.9个月后两组患者消化道出血复发率分别为10％、7.69％,12个月后的复发率分别为15％、11.5％.配对t检验统计显示,TIPSS术6～12个月后,应用直径较小（8 mm组）的PTFE覆膜支架,患者的消化道出血复发率和分流道的远期狭窄闭塞率明显低于10mm组（t=23.16,P＜0.01;t=14.21,P＜0.01）.结论 TIPSS术中应用直径较小的PTFE覆膜支架（如8mm直径）,能够在达到分流效果的同时,减少中远期分流道狭窄率等并发症,患者预后较好.

Effect of PTFE covered stent with different diameters in TIPSS surgery of portal hypertension

Objective To analyze effect of the different diameters （10 mm and 8 mm） PTFE covered stent in transjugular intrahepatic portosystemic stent shunt （TIPSS） surgery. Methods The clinical data of 46 patients who were diagnosed as portal hypertension and underwent TIPSS surgery was collected, including 20 patients treated with conventional 10 mm PTFE covered stent （10 mm group） and 26 patients with smaller diameter of 8 mm poly tetra fluo- ro ethylene （PTFE） covered stent （8 mm group）. Portal vein pressure of the 46 patients was measured one week after surgery, as well as the initial opening ratio of shunt vein. The narrow ratio of shunt vein at different postoperative time points （3 months, 6 months, 9 months and 12 months） as well as the incidence of h~atic enccphalopathy were detected. Results TIPSS surgery were successful and vital signs were stable intraoperative in 46 patients （100%）, with no seri- ous complications occurred. The ultrasound results of two groups showed initial opening ratio of shunt vein were both 100%. The portal pressure of the two groups was （22.4~3.5） cmH20, （23.2~3.7） cmH20, respectively, significantly lower than the preoperative level. The fasting blood ammonia was （41.3~11.39） ~tg/L, （42.4~11.78） ~tg/L, respectively, slightly increased than preoperative level, with no significant difference between the two groups. The recurrence rate of gastrointestinal bleeding in the two groups was 10%, 7.69% 9 months after surgery, and 15%, 11.5% 12 months af- ter surgery, respectively. Paired t-test statistics showed that the relapse rate of gastrointestinal bleeding and forward ste- nosis or occlusion of shunt vein in 8 mm group were significantly lower than those in 10 mm group （t=23.16, P〈0.01; t=14.21, P〈0.01）. Conclusion The application of a smaller diameter PTFE covered stent （8 mm in diameter） of TIPSS would reach enough shunt effect and lower occurrence of complications such as stenosis or occlusion of shunt vein or stenosis in the long-term, Withbetter prognosis.