摘要
目的评估采用不同支架经颈静脉肝内门体静脉分流术（TIPS）治疗肝硬化食管胃静脉曲张出血的安全性和临床疗效。方法回顾性研究105例TIPS治疗肝硬化食管胃静脉曲张出血的裸支架组、覆膜支架组和联合支架组患者的手术成功率、分流道失功能率、再出血率、生存率和主要并发症。TIPS术后6、12和24个月分流道失功能率、再出血率、生存率使用寿命表法计算，并对整个随访期内TIPs术后分流道失功能率、再出血率、生存率作出Kaplan-Meier分析曲线及行Log-rank检验，以P〈0．05为差异有统计学意义。结果不同支架TIPS治疗肝硬化食管胃静脉曲张出血的总体手术成功率为10％。TIPS术后6、12、24个月总体分流道失功能率分别为8％、9％、16％；再出血率分别为2％、6％、17％，生存率分别为100％、97％、94％。在整个随访期内，裸支架组、覆膜支架组和联合支架组分流道失功能率为26％、14％、5％，三组比较，X2=1．00，P=0．61，差异无统计学意义，再出血率分别为33％、7％、3％，三组比较，X2=1．69，P=0．43，差异无统计学意义；生存率分别为92％、93％、10％，三组比较，X2=1．91，P=0．39，差异无统计学意义。脾切除患者较非脾切除患者分流道失功能率明显升高（30％对比14％），X2=4．15，P=0．04，差异有统计学意义。覆膜支架组和联合支架组腹腔内出血率均为0，显著低于裸支架组的13％，X2=8．88，P=0．01，差异有统计学意义。结论采用8mm支架TIPS可以有效治疗和预防肝硬化食管胃静脉曲张破裂出血。覆膜支架和联合支架显著减少TIPS相关腹腔内出血，提高治疗安全性，但对临床疗效的影响有待深入研究。
Objective To assess the safety and clinical efficacy of transjugular intrahepatic portosystemic shunt （TIPS） with various stents for treating patients with cirrhosis and esophageal gastric varices bleeding. Methods One hundred and five patients were stratified according to stent type： bare stent group, covered stent- gratis group, combined stents group. Rates of success, shunt insufficiency, rebleeding, patient survival, and major complications were observem The shunt insufficiency rate, rebleeding rate, and survival rate were calculated by the life tables method, the Kaplan-Meier analytical curve, and the log-rank test; a p-value less than 0.05 was considered statistically significant. Results The overall success rate of all TIPS for treating the esophageal gastric varices bleeding was 100%. The overall shunt insufficiency rates at 6-, 12- and 24-months post-TIPS were 8%, 9% and 16%, rebleeding rates were 2%, 6% and 17%, and survival rates were 100%, 97% and 94%. The shunt insufficiency rate was 26% in the bare stent group, 14% in the covered stent-grafts group, and 5% in the combined stents group 2 = 1.00, P = 0.61）. The rebleeding rate was 33% in the bare stent group, 7% in the covered stent-gratts group, and 3% in the combined stents group （X2 = 1.69,P = 0.43）. The survival rate was 92% in the bare stent group, 93% in the covered stent-grafis group, and 100% in the combined stents group （X2 = 1.91,P = 0.39）. The shunt insufficiency rates were higher in patients with splenectomy than in those without splenectomy （30% vs. 14%; X2 = 4.15,P = 0.04）. The intrapefitoneal hemorrhage rates in the covered stent-gratts group and the combined stents group were significantly lower than that in the bare stent group （0% vs 0% vs 13%;X2 = 8.88, P = 0.01 ）. Condusions TIPS with an 8 mm stent effectively treated and prevented esophageal gastric varices bleeding in patients with cirrhosis. Intraperitoneal hemorrhaging caused by TIPS was significantly decreased in the covered stent-grafts group and combined stents group, which represented an improvement in safety of this treatment. However, the influence of covered stent-grafis and combined stents towards the clinical efficacy of TIPS needs further study.
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2015年第4期258-264,共7页
Chinese Journal of Hepatology
基金
南京市卫生局重点课题
关键词
门体静脉分流术
经颈静脉肝内
疗效
安全性
裸支架
覆膜支架
Portosystemic shunt, transjugular intrahepatic
Clinical efficacy
Safety
Bare stent
Covered stent-grafts
