CAJ | 학술논문

目的探讨采用聚四氟乙烯(PTFE)覆膜支架行经颈静脉肝内门腔分流术(TIPS)的临床疗效.方法回顾性分析行PTFE覆膜支架TIPS术治疗的102例门静脉高压症患者的临床资料,其中男82例、女20例,年龄16 ～ 73岁,平均(53±13)岁.术前症状为食管胃底静脉曲张大出血(83例)或顽固性腹水(19例),肝功能Child-Pugh评分5.0 ～10.0分,平均(6.7±1.7)分.患者均采用PTFE覆膜支架行TIPS术.手术前后门静脉压力和肝功能评分的比较采用t检验.采用寿命表法绘制术后6、12、24、36、48个月的分流道开通率、术后生存率、术后肝性脑病(HE)的发生率曲线.结果全部患者均在局部麻醉下成功建立肝内门腔覆膜支架分流道,共置入支架128枚.支架直径6.0～10.0mm,平均(8.1 ±0.9)mm.其中PTFE覆膜支架104枚,裸支架24枚.术后门静脉压力明显下降,术前平均(28.5±5.3)mm Hg(1 mm Hg=0.133 kPa),术后(18.0±4.5)mm Hg,手术前后差异有统计学意义(t =22.8,P＜0.01).3例患者出现围手术期并发症,2例腹腔出血、1例支架周围感染.术后随访0 ～58个月,平均(20±13)个月.术后3个月肝功能Child-Pugh评分(6.5±1.6)分,与术前相比[(6.7±1.7)分]差异无统计学意义(t=0.8,P＞0.05).患者术后6、12、24、36、48个月的覆膜支架分流道一期累积通畅率分别是96％、91％、82％、82％、82％,随访期间10例患者出现覆膜支架分流道再狭窄,总体一期再狭窄率为9.8％；27例出现术后HE,发生率26.5％,累积发生率分别为7％、21％、34％、46％、66％；16例出现死亡,病死率为15.7％,累积生存率分别是95％、83％、76％、76％、76％.结论与裸支架相比,采用PTFE覆膜支架行TIPS术在技术上安全可行,可以明显提高TIPS术后分流道通畅率,但如何改善术后HE及生存率仍是目前亟待解决的问题.
목적 탐토채용취사불을희(PTFE)복막지가행경경정맥간내문강분류술(TIPS)적림상료효.방법 회고성분석행PTFE복막지가TIPS술치료적102례문정맥고압증환자적림상자료,기중남82례、녀20례,년령16 ～ 73세,평균(53±13)세.술전증상위식관위저정맥곡장대출혈(83례)혹완고성복수(19례),간공능Child-Pugh평분5.0 ～10.0분,평균(6.7±1.7)분.환자균채용PTFE복막지가행TIPS술.수술전후문정맥압력화간공능평분적비교채용t검험.채용수명표법회제술후6、12、24、36、48개월적분류도개통솔、술후생존솔、술후간성뇌병(HE)적발생솔곡선.결과 전부환자균재국부마취하성공건립간내문강복막지가분류도,공치입지가128매.지가직경6.0～10.0mm,평균(8.1 ±0.9)mm.기중PTFE복막지가104매,라지가24매.술후문정맥압력명현하강,술전평균(28.5±5.3)mm Hg(1 mm Hg=0.133 kPa),술후(18.0±4.5)mm Hg,수술전후차이유통계학의의(t =22.8,P＜0.01).3례환자출현위수술기병발증,2례복강출혈、1례지가주위감염.술후수방0 ～58개월,평균(20±13)개월.술후3개월간공능Child-Pugh평분(6.5±1.6)분,여술전상비[(6.7±1.7)분]차이무통계학의의(t=0.8,P＞0.05).환자술후6、12、24、36、48개월적복막지가분류도일기루적통창솔분별시96％、91％、82％、82％、82％,수방기간10례환자출현복막지가분류도재협착,총체일기재협착솔위9.8％；27례출현술후HE,발생솔26.5％,루적발생솔분별위7％、21％、34％、46％、66％；16례출현사망,병사솔위15.7％,루적생존솔분별시95％、83％、76％、76％、76％.결론 여라지가상비,채용PTFE복막지가행TIPS술재기술상안전가행,가이명현제고TIPS술후분류도통창솔,단여하개선술후HE급생존솔잉시목전극대해결적문제.
Objective To evaluate the clinical application of transjugular intrahepatic portosystemic shunt (TIPS) with polytetrafluoroethylene (PTFE) covered stent for the treatment of portal hypertension.Methods One hundred and two patients (82 men and 20 women; mean age:53) with portal hypertension caused by liver cirrhosis underwent TIPS with PTFE covered stent (Fluency stent,Bard Corp).Preoperative symptoms were variceal bleeding (n =83),or refractory ascites (n =19).The number of patients who had Child-Pugh class A,B,and C cirrhosis were 55,41,9,respectively.Additionally,the cumulative patency of shunt with covered stent,the incidence rate of hepatic encephalopathy (HE) and survival rate of all patients were calculated at 3,6,12,24,36,48 months after TIPS with the life-table method.T test was used for statistics.Results The procedure was successful in all patients.The mean portosystemic pressure of portal vein decreased from 28.5 mm Hg to 18.0 mm Hg(t =22.8,P ＜0.01).Three patients developed TIPS-related complications (two cases of serious hemoperitoneum and one of infection around covered stent).During the follow-up,shunt restenosis occurred in 10 patients (9.8％),and the cumulative primary patency rates were 96％,91％,82％,82％ and 82％ at 6,12,24,36 and 48 months,respectively.Postprocedural HE occurred in 27 patients (26.5％),and the cumulative HE rates were 7％,21％,34％,46％ and 66％ at 6,12,24,36 and 48 months,respectively.The overall mortality rare was 15.7％ (n =16),and the cumulative survival rates were 95％,83％,76％,76％ and 76％ at 6,12,24,36 and 48 months,respectively.Conclusions The PTFE covered stent is safe and effective in TIPS,with clear improvement of shunt patency,while how to improve the postoperative HE and survival rates are urgently needed to be solved.