肝硬化门静脉高压患者行经颈静脉肝内门体分流术术中置入Viatorr支架分流门静脉左、右支血流对疗效的影响

姚欣; 周昊; 汤善宏; 黄山; 陈雪玲; 秦建平

doi:10.3969/j.issn.1001-5256.2020.09.012

肝硬化门静脉高压患者行经颈静脉肝内门体分流术术中置入Viatorr支架分流门静脉左、右支血流对疗效的影响

DOI: 10.3969/j.issn.1001-5256.2020.09.012

解放军西部战区总医院消化内科

基金项目:

原成都军区总医院基金项目(2013YG-B009)；

详细信息

中图分类号: R654.3
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出版历程
- 出版日期: 2020-09-20

Effect of intraoperative Viatorr stent implantation for shunting of blood flow in the left or right branch of the portal vein and its effect on clinical outcome in patients with cirrhotic portal hypertension undergoing transjugular intrahepatic portosystemic shunt

Department of Gastroenterology, The General Hospital of Western Theater Command

Research funding:

摘要

摘要:
目的探讨在经颈静脉肝内门体分流术（TIPS）术中置入Viatorr支架分流门静脉左支或右支血流对肝硬化门静脉高压患者疗效的影响。方法回顾性分析中国人民解放军西部战区总医院2016年3月-2019年12月接受TIPS治疗的肝硬化门静脉高压症120例患者的临床资料,根据术中造影判断穿刺门静脉靶点位置,将患者分为门静脉左支分流组（n=52）和右支分流组（n=68）,分析两组患者术后复发出血、支架功能障碍、肝性脑病发生及生存状况。计量资料2组间比较采用t检验。计数资料2组间比较采用χ2检验。Kaplan-Meier曲线分析再出血率、支架通畅率、肝性脑病发生率及生存率。结果 120例患者手术成功率100%,近期止血率100%。门静脉压力术后较术前明显降低[（9.98±2.84） mm Hg vs （24.72±5.11） mm Hg,t=37.76,P <0.01]。累计再出血率术后12、24个月分别为3.2%、11.0%;肝性脑病累计发生率术后3、6、12、24个月分别为10.8%、13.6%、21.2%、24.5%;随访24个月累计29例肝性恼病患者中,Ⅰ+Ⅱ级23例,Ⅲ级6例;支架功...
- 肝硬化 /
- 高血压,门静脉 /
- 门体分流术,经颈静脉肝内 /
- Viatorr支架
Abstract:
Objective To investigate the effect of intraoperative Viatorr stent implantation for shunting of blood flow in the left or right branch of the portal vein on the clinical outcome of patients with cirrhotic portal hypertension undergoing transjugular intrahepatic portosystemic shunt( TIPS). Methods A retrospective analysis was performed for the clinical data of 120 patients with cirrhotic portal hypertension who underwent TIPS in The General Hospital of Western Theater Command from March 2016 to December 2019,and according to the target position of portal vein puncture determined by intraoperative angiography,the patients were divided into left branch group and right branch group.The two groups were compared in terms of the incidence rates of postoperative recurrence and bleeding,stent dysfunction,and hepatic encephalopathy( HE) and survival. The t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier curve was used to calculate rebleeding rate,stent patency rate,incidence rate of HE,and survival rate. Results The surgical success rate was 100% for all 120 patients,with a short-term hemostasis rate of100%. Among the 120 patients,52 underwent shunting of the left branch of the portal vein and 68 underwent shunting of the right branch.There was a significant reduction in portal venous pressure after surgery( 9. 98 ± 2. 84 mm Hg vs 24. 72 ± 5. 11 mm Hg,t = 37. 76,P < 0. 01).The cumulative rebleeding rates at 12 and 24 months after surgery were 3. 2% and 11. 0%,respectively,and the cumulative incidence rates of HE at 3,6,12,and 24 months after surgery were 10. 8%,13. 6%,21. 2%,and 24. 5%,respectively. Among the 29 patients who experienced HE,23 had gradeⅠ-ⅡHE and 6 had grade Ⅲ HE. The cumulative incidence rates of stent dysfunction at 12 and 24 months after surgery were 7. 1% and 21. 4%,respectively. The cumulative survival rates at 12 and 24 months after surgery were 92. 0% and 86. 5%,respectively.As for comparison of the left branch group and the right branch group,there were no significant differences in postoperative stent patency rate,rebleeding rate,incidence rate of HE,and survival rate( all P < 0. 05). Conclusion TIPS is a safe and effective method for the treatment of cirrhotic portal hypertension,and intraoperative Viatorr stent implantation,no matter for establishing the shunt of the left or right branch of the portal vein,will not affect the clinical outcome of patients.
- liver cirrhosis /
- hypertension,portal /
- portasystemic shunt,transjugular intrahepatic /
- Viatorr stent

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参考文献(22)

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