[1]马鹍鹏,梁松年,钟红珊,等.Viatorr支架行TIPS术治疗门静脉高压性静脉曲张消化道出血效果评估[J].介入放射学杂志,2020,29(04):380-384.
　MA Kunpeng,LIANG Songnian,ZHONG Hongshan,et al.TIPS creation by using Viatorr stent-graft for the treatment of variceal gastrointestinal bleeding due to portal hypertension: evaluation of its clinical efficacy[J].journal interventional radiology,2020,29(04):380-384.
点击复制

Viatorr支架行TIPS术治疗门静脉高压性静脉曲张消化道出血效果评估()

PDF下载中关闭

分享到：

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
29
期数:
2020年04
页码:
380-384
栏目:
临床研究
出版日期:
2020-05-08

文章信息/Info

Title:
TIPS creation by using Viatorr stent-graft for the treatment of variceal gastrointestinal bleeding due to portal hypertension: evaluation of its clinical efficacy
作者:
马鹍鹏; 梁松年; 钟红珊; 罗婷; 张强健; 李东奇; 王子璇; 徐克
Author(s):
MA Kunpeng;  LIANG Songnian;  ZHONG Hongshan;  LUO Ting;  ZHANG Qiangjian;  LI Dongqi;  WANG Zixuan;  XU Ke.
Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province 110001, China
关键词:
【关键词】　经颈静脉肝内门体分流术; Viatorr支架; 肝硬化门静脉高压症; 静脉曲张消化道出血
文献标志码:
A
摘要:
【摘要】　目的?评价应用Viatorr支架行经颈静脉肝内门体分流术（TIPS）术治疗门静脉高压性静脉曲张消化道出血的可行性、安全性和临床效果。方法?回顾性分析2015年10月至2018年11月收治的42例肝硬化门静脉高压性静脉曲张消化道出血患者临床资料，所有患者符合TIPS治疗指征，均接受Viatorr支架行TIPS术治疗。术中检测门静脉压力梯度（PPG）。术后1、3、6、12个月，之后每年随访超声或增强CT检查，评价分流道通畅情况，并通过电子病历、临床或电话随访患者肝功能、凝血4项、再出血、肝性脑病发生和生存时间。配对t检验分析术前、术后PPG、总胆红素、血清白蛋白和凝血酶原时间变化，Kaplan-Meier法分析分流道通畅率和生存率。结果?42例均成功施行TIPS术，技术成功率为100%。共植入直径8 mm Viatorr支架42枚。PPG均值由术前（26.85±6.00） mmHg（1 mmHg=0.133 kPa）降低为（11.62±4.54） mmHg（t=11.359，P＜0.05），平均降低（55.63±16.77）%。与术前相比，术后3 d总胆红素浓度升高（P＜0.05），血清白蛋白降低（P＜0.05），凝血酶原时间延长（P＜0.05）。术后1个月总胆红素、血清白蛋白和凝血酶原时间与术前水平差异均无统计学意义（P＞0.05）。术后中位随访14.5（2～39）个月，再出血发生率为9.5%（4/42），其中1例接受分流道再通；肝性脑病发生率为19.1%（8/42）。术后1、2、3年分流道通畅率分别为91.9%、83.9%、77.4%，生存率分别为94.7%、89.4%、82.0%。肝硬化相关死亡率为9.5%（4/42），均于术后2～30个月死于终末期肝病伴多脏器功能衰竭。结论?Viatorr支架行TIPS术治疗肝硬化门静脉高压性静脉曲张消化道出血具有较高的技术成功率，术后分流道通畅率高，肝性脑病发生率低。

参考文献/References:

[1] 孙旻煌， 李迎春， 李松蔚， 等. Viatorr支架在TIPS治疗中的应
用[J]. 介入放射学杂志， 2019， 28：166-169.
[2] 张?铠， 赵?卫. TIPS联合胃冠状静脉栓塞治疗肝硬化门静脉高压伴上消化道出血[J]. 介入放射学杂志， 2017， 26：601-606.
[3] 韩?强， 李迎春， 李松蔚， 等. 经颈静脉肝内门体分流双支架技术研究进展[J]. 介入放射学杂志， 2017， 26：859-861.
[4] 鲍应军， 顾俊鹏， 张海潇， 等. 采用Viatorr支架行TIPS治疗门静脉高压症疗效[J]. 中国介入影像与治疗学， 2019， 16：12-15.
[5] 中华医学会放射学分会介入学组. 经颈静脉肝内门体分流术专家共识[J]. 临床肝胆病杂志， 2017， 33：1218-1228.
[6] Bureau C, Pagan JC, Layrargues GP, et al. Patency of stents covered with polytetrafluoroethylene in patients treated by transjugular intrahepatic portosystemic shunts: long-term results of a randomized multicentre study[J]. Liver Int, 2007, 27: 742-747.
[7] Cura M, Cura A, Suri R, et al. Causes of TIPS dysfunction[J]. AJR Am J Roentgenol, 2008, 191: 1751-1757.
[8] Sauerbruch T, Mengel M, Dollinger M, et al. Prevention of rebleeding from esophageal varices in patients with cirrhosis receiving small-diameter stents versus hemodynamically controlled medical therapy[J]. Gastroenterology, 2015, 149: 660.e1-668.e1.
[9] Wang Q, Lv Y, Bai M, et al. Eight millimetre covered TIPS does not compromise shunt function but reduces hepatic encephalopathy in preventing variceal rebleeding[J]. J Hepatol, 2017, 67: 508–516.
[10] Hsu MC, Weber CN, Stavropoulos SW, et al. Passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts and assessment of clinical outcomes[J]. World J Hepatol, 2017, 9: 603-612.
[11] Fonio P，Discalzi A，Calandri M，et al. Incidence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt （TIPS） according to its severity and temporal grading classification[J]. Vadiol Med，2017，122: 713-721.
[12] Rössle M, Siegerstetter V, Olschewski M, et al. How much reduction in portal pressure is necessary to prevent variceal rebleeding?
A longitudinal study in 225 patients with transjugular intrahepatic portosystemic shunts[J]. Am J Gastroenterol, 2001, 96: 3379-3383.
[13] 张文广. 门静脉高压及门静脉海绵样变经颈静脉肝内门体分流术的相关研究[D]. 郑州： 郑州大学， 2017.
[14] Jiang Q, Wang MQ, Zhang GB, et al. Transjugular intrahepatic portosystemic shunt combined with esophagogastric variceal embolization in the treatment of a large gastrorenal shunt[J]. World J Hepatol, 2016, 8: 850.
[15] Park EJ, Jang JY, Lee JE, et al. The risk factors for bleeding of fundal varices in patients with liver cirrhosis[J]. Gut Liver, 2013, 7: 704-711.
[16] Weber CN, Nadolski GJ, White SB, et al. Long-term patency and clinical analysis of expanded polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunt stent grafts[J]. J Vasc Interv Radiol, 2015, 26: 1257-1265.
[17] Rössle M, Siegerstetter V, Euringer W, et al. The use of a polytetrafluoroethylene-covered stent graft for transjugular intrahepatic portosystemic shunt （TIPS）: long-term follow-up of 100 patients[J]. Acta Radiol, 2006, 47: 660-666.
[18] Luca A, Miraglia R, Caruso S, et al. Short- and long-term effects of the transjugular intrahepatic portosystemic shunt on portal vein thrombosis in patients with cirrhosis[J]. Gut, 2011, 60: 846-852.
[19] Wang L, Xiao Z, Yue Z, et al. Efficacy of covered and bare stent in tips for cirrhotic portal hypertension: a single-center randomized trial[J]. Sci Rep, 2016, 6: 21011.
[20] Wu Q, Jiang J, He Y, et al. Transjugular intrahepatic portosystemic shunt using the FLUENCY expanded polytetrafuoroethylene-covered stent[J]. Exp Ther Med, 2013, 5: 263-266.
[21] Saad WE, Darwish WM, Davies MG, et al. Stent-grafts for transjugular intrahepatic portosystemic shunt creation: specialized TIPS stent-graft versus generic stent-graft/bare stent combination[J]. J Vasc Interv Radiol, 2010, 21: 1512-1520.
[22] Tripathi D, Ferguson J, Barkell H, et al. Improved clinical outcome with transjugular intrahepatic portosystemic stent-shunt utilizing polytetrafluoroethylene-covered stents[J]. Eur J Gastroenterol Hepatol, 2006, 18: 225-232.
[23] 丁智锋， 殷世武， 张国兵， 等. Viatorr支架与双支架技术行经颈静脉肝内门体分流术的临床疗效观察[J]. 临床肝胆病杂志, 2018， 34：579-583.
[24] Gaba RC, Omene BO, Podczerwinski ES, et al. TIPS for treatment of variceal hemorrhage: clinical outcomes in 128 patients at a single institution over a 12-year period[J]. J Vasc Interv Radiol , 2012, 23: 227-235.
[25] Angermayr B, Cejna M, Koenig F, et al. Survival in patients undergoing transjugular intrahepatic portosystemic shunt: ePTFE-covered stentgrafts versus bare stents[J]. Hepatology, 2003, 38: 1043-1050.
[26] Xue H, Yuan J, Chao-Li Y, et al. Follow-up study of transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension[J]. Dig Dis Sci, 2011, 56: 3350-3356.

相似文献/References:

[1]唐世伟,赵新建,王忠敏,等.TIPS对比EBL治疗肝硬化食管静脉曲张出血Meta分析[J].介入放射学杂志,2016,(09):761.
　TANG Shi- wei,ZHAO Xin- jian,WANG Zhong- min,et al.The treatment of cirrhosis esophageal variceal bleeding： a meta- analysis of TIPS versus EBL[J].journal interventional radiology,2016,(04):761.
[2]彭伦华,王运兵,郭 灿.球囊阻断逆行经静脉闭塞对比经颈静脉肝内门体分流治疗门脉高压胃底静脉曲张出血的Meta分析[J].介入放射学杂志,2016,(10):843.
　PENG Lun- hua,WANG Yun- bing,GUO Can.Balloon- occluded retrograde transvenous obliteration versus TIPS for treatment of gastric fundus varices due to portal hypertension： a meta- analysis[J].journal interventional radiology,2016,(04):843.
[3]苗同国,褚建国,黄 鹤,等.经颈静脉肝内门静脉左支门体分流中支架位置对远期疗效的影响 [J].介入放射学杂志,2017,(04):299.
　MIAO Tongguo,CHU Jianguo,HUANG He,et al.The influence of the stent position in transjugular intrahepatic left branch of portal vein portosystemic shunt on the long- term effect[J].journal interventional radiology,2017,(04):299.
[4]韩 强,李迎春,李松蔚,等.经颈静脉肝内门体分流双支架技术研究进展 [J].介入放射学杂志,2017,(09):859.
　HAN Qiang,LI Yingchun,LI Songwei,et al.Dual stent technology used for TIPS： recent progress in research[J].journal interventional radiology,2017,(04):859.
[5]胡晓钢,金红来,鲁 军,等.经颈静脉肝内门体分流术治疗门静脉血栓形成伴急性消化道大出血效果评价[J].介入放射学杂志,2018,27(06):516.
　HU Xiaogang,JIN Honglai,LU Jun,et al.TIPS for the treatment of portal vein thrombosis associated with acute massive hemorrhage of gastrointestinal tract： evaluation of clinical effect[J].journal interventional radiology,2018,27(04):516.
[6]邓黎严琰,陈 勇,叶 鹏,等.经颈静脉肝内门体分流术初步分析门静脉系统肝脏相关血液成分[J].介入放射学杂志,2020,29(06):608.
　DENG Liyanyan,CHEN Yong,YE Peng,et al.Preliminary analysis of liver- related blood components in portal vein system via TIPS approach[J].journal interventional radiology,2020,29(04):608.
[7]于 翔,谢 坪,成思航,等.经颈静脉肝内门体分流术前外周血炎症指标对术后肝性脑病的预测价值 [J].介入放射学杂志,2021,30(09):937.
　YU Xiang,XIE Ping,CHENG Sihang,et al.The clinical value of preoperative peripheral blood inflammatory markers in predicting the occurrence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt[J].journal interventional radiology,2021,30(04):937.
[8]曾 娇,郭贵海.经颈静脉肝内门体分流术支架选择和释放位置研究进展[J].介入放射学杂志,2021,30(09):964.
　ZENG Jiao,GUO Guihai..Research progress in the selection of the stent and its release site in TIPS therapy[J].journal interventional radiology,2021,30(04):964.
[9]高西杰,赵剑波,谭 卿,等.Viatorr支架经颈静脉肝内门体分流术后显性肝性脑病发生率及其危险因素分析[J].介入放射学杂志,2021,30(10):998.
　GAO Xijie,ZHAO Jianbo,TAN Qing,et al.Overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt with Viatorr stent： analysis of its incidence and risk factors[J].journal interventional radiology,2021,30(04):998.
[10]徐文海,许 伟,祖茂衡,等.经导管动脉化疗栓塞治疗经颈静脉肝内门体分流术后肝细胞癌临床应用评价 [J].介入放射学杂志,2021,30(10):1052.
　XU Wenhai,XU Wei,ZU Maoheng,et al.Clinical application of transcatheter arterial chemoembolization in treating patients with hepatocellular carcinoma after receiving transjugular intrahepatic portosystemic shunt[J].journal interventional radiology,2021,30(04):1052.

备注/Memo

备注/Memo:
（收稿日期：2019-03-15）
（本文编辑：边?佶）
更新日期/Last Update: 2020-05-06