[1]窦树彬,陆圣月.改良经颈静脉肝内门体分流术双支架植入治疗肝硬化门静脉高压临床效果[J].介入放射学杂志,2023,32(02):127-130.
 DOU Shubin,LU Shengyue..Modified transjugular intrahepatic portosystemic shunt and double-stent implantation technique in the treatment of cirrhotic portal hypertension: analysis of its clinical effect [J].journal interventional radiology,2023,32(02):127-130.
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改良经颈静脉肝内门体分流术双支架植入治疗肝硬化门静脉高压临床效果()

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

卷:
32
期数:
2023年02
页码:
127-130
栏目:
血管介入
出版日期:
2023-03-03

文章信息/Info

Title:
Modified transjugular intrahepatic portosystemic shunt and double-stent implantation technique in the treatment of cirrhotic portal hypertension: analysis of its clinical effect
作者:
窦树彬 陆圣月
Author(s):
DOU Shubin LU Shengyue.
Department of Cardiovascular Surgery, No.960 Hospital of Chinese People’s Liberation Army, Jinan, Shandong Province 250031, China
关键词:
【关键词】 双支架技术门静脉高压肝硬化经颈静脉肝内门体分流术
文献标志码:
A
摘要:
【摘要】 目的 探讨采用改良经颈静脉肝内门体分流术(TIPS)和双支架植入治疗肝硬化门静脉高压的安全性和有效性。方法 回顾性分析2016年3月至2021年5月在解放军第九六〇医院接受治疗的92例肝硬化门静脉高压患者临床资料。对常规TIPS穿刺技术进行改良,采用覆膜支架和裸支架建立分流道,测量TIPS术前后门静脉主干压力。术后3、6、12、24、36个月进行规律随访,复查超声或CT,了解支架通畅情况。结果 92例患者完成TIPS术(常规TIPS 22例,改良TIPS 70例),技术成功率100%。术后血管造影显示支架内血流通畅,无手术相关严重并发症发生。门静脉主干压力由术前(44.1±6.8) cmH2O降低为术后(23.0±3.4) cmH2O,差异有统计学意义(P<0.01)。所有患者随访(21.4±7.9)个月(3~43个月),85例支架内血流通畅,4例分别于术后10、13、24、33个月出现分流道闭塞,再次植入1枚支架后血流恢复通畅,3例分别于术后4、18、30个月死于多脏器衰竭或消化道出血。术后1年、2年、3年累计支架通畅率分别为98.9%、96.7%、95.7%。结论 改良TIPS穿刺技术安全可行,双支架植入治疗肝硬化门静脉高压患者近中期临床效果满意。

参考文献/References:

[1] 张建龙,李迎春,李松蔚. TIPS术后支架狭窄或闭塞的研究现状[J]. 世界华人消化杂志,2015,23:5311-5317.
[2] Richter GM, Palmaz JC, Nöldge G, et al. The transjugular intrahepatic portosystemic stent-shunt. A new nonsurgical percutaneous method[J]. Radiologe, 1989, 29: 406-411.
[3] Corbett C, Mangat K, Olliff S, et al. The role of Transjugular Intrahepatic Portosystemic Stent-Shunt (TIPSS) in the management of variceal hemorrhage[J]. Liver Int, 2012, 32: 1493-1504.
[4] Wang P, Qi X, Xu K. Evolution, progress, and prospects of research on transjugular intrahepatic portosystemic shunt applications[J]. J Interv Med, 2021, 4: 57-61.
[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]. 中华放射学杂志,2017,51:324-333.
[6] 卫生部医政司. 外周血管介入诊疗技术管理规范[J]. 中国医药科学,2012,2:6-8.
[7] 姜绍连,李 威,周 石. 三种支架用于经颈静脉肝内门体静脉分流术的安全性及疗效分析[J]. 中国介入影像与治疗学,2017,14:343-346.
[8] Satapathy SK, Sanyal AJ. Nonendoscopic management strategies for acute esophagogastric variceal bleeding[J]. Gastroenterol Clin North Am, 2014, 43: 819.
[9] 葛世堂,窦树彬,张希全. 改良经颈静脉肝内门体静脉分流术双支架植入治疗肝硬化门静脉高压的疗效分析[J]. 中华普通外科杂志,2021,36:695-697.
[10] Wang Q, Lv Y, Bai M, et al. Eight millimetre covered TIPS does not compromise shunt function but reduces hepatic encephalopathy inpreventing variceal rebleeding[J]. J Hepatol, 2017, 67: 508-516.
[11] 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.
[12] 蒋天鹏,王黎洲,李 兴,等. 经颈静脉肝内门体分流术手术使用全覆膜支架[J]. 世界华人消化杂志,2013,21:3265-3269.
[13] 蒋明明,徐 浩,张庆桥,等. 经颈静脉肝内门体分流术在门静脉高压并发顽固性腹水及静脉曲张出血患者个体化治疗中的初步应用[J]. 中华医学杂志,2019,99:3737-3740.
[14] 刘 芳,赵剑波,王江云,等. 采用专用覆膜支架行经颈静脉肝内门体分流术2年随访观察[J]. 介入放射学杂志,2021,30:888-892.
[15] Qi X, Liu L, Bai M, et al. Transjugular intrahepatic portosystemic shunt in combination with or without variceal embolization for the prevention of variceal rebleeding: a meta-analysis[J]. J Gastroenterol Hepatol, 2014, 29: 688-696.

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备注/Memo

备注/Memo:
(收稿日期:2021-12-30)
(本文编辑:边 佶)
更新日期/Last Update: 2023-03-03