Angermayr Bernhard, Cejna Manfred, Koenig Franz, Karnel Franz, Hackl Franz, Gangl Alfred, Peck-Radosavljevic Markus
Department of Gastroenterology and Hepatology, University of Vienna Medical School, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Hepatology. 2003 Oct;38(4):1043-50. doi: 10.1053/jhep.2003.50423.
In patients with liver cirrhosis, implantation of a transjugular intrahepatic shunt (TIPS) leads to reduction of portal pressure, but not of mortality compared with other therapies. The high stenosis rates of conventional bare stents causes high reintervention rates and costs and may be correlated with poor survival. ePTFE-covered stentgrafts provide much improved patency rates, but their impact on survival is unclear. All suitable patients receiving either bare TIPS (419/466) or undergoing implantation of ePTFE endoprostheses (89/100) in several centers in Austria up to 2002 were included in this retrospective analysis. Both patient groups were compared regarding survival with Kaplan-Meier and Cox regression analysis. Unmatched and 1:1-matched survival analyses were performed. Patients undergoing ePTFE stentgraft implantation had significantly higher survival rates in all analyses. The 3-month, 1-year, and 2-year survival rates were 93%, 88%, and 76% for the ePTFE-group and 83%, 73%, and 62% for conventional TIPS patients, respectively. The matched survival analyses validated these findings. The model of the stent, patient age, and Child-Pugh Class (CPC) were independent predictors of survival. In conclusion, patients undergoing ePTFE-endoprosthesis implantation had higher survival rates within 2 years after TIPS-implantation. This may be the result of improved patency rates after correct placement (up to the inferior caval vein [ICV]) of the ePTFE stentgraft. These data should be validated in a prospective series.
在肝硬化患者中，经颈静脉肝内门体分流术（TIPS）可降低门静脉压力，但与其他治疗方法相比，并未降低死亡率。传统裸支架的高狭窄率导致高再干预率和成本，且可能与生存率低相关。聚四氟乙烯（ePTFE）覆膜支架移植物的通畅率有显著提高，但其对生存率的影响尚不清楚。截至2002年，奥地利多个中心所有接受裸TIPS（419/466）或植入ePTFE内支架（89/100）的合适患者均纳入本回顾性分析。采用Kaplan-Meier法和Cox回归分析比较两组患者的生存率。进行了非配对和1:1配对生存分析。在所有分析中，接受ePTFE支架移植物植入的患者生存率显著更高。ePTFE组的3个月、1年和2年生存率分别为93%、88%和76%，传统TIPS患者分别为83%、73%和62%。配对生存分析验证了这些结果。支架型号、患者年龄和Child-Pugh分级（CPC）是生存的独立预测因素。总之，TIPS植入术后2年内，接受ePTFE内支架植入的患者生存率更高。这可能是ePTFE支架移植物正确放置（直至下腔静脉[ICV]）后通畅率提高的结果。这些数据应在前瞻性研究中得到验证。
