Ockenga J, Kroencke T J, Schuetz T, Plauth M, Kasim E, Petersein J, Schmidt H H-J, Lochs H
Medizinische Klinik mit Schwerpunkt Gastroenterologie, Hepatologie und Endokrinologie, Charité Universitätsmedizin Berlin, Germany.
Scand J Gastroenterol. 2004 Oct;39(10):994-9. doi: 10.1080/00365520410003443.
The purpose of this study was to evaluate the patency, functional and haemodynamic results of expanded-polytetrafluoroethylene (ePTFE)-covered transjugular intrahepatic portosystemic shunts in patients with liver cirrhosis.
Thirteen patients with an ePTFE-covered transjugular intrahepatic portosystemic shunt stent (TIPSS) were prospectively evaluated at 6 and 12 months and compared with matched controls with mesh-wire uncovered TIPSS.
At 6 months, ePTFE-TIPSS showed a significantly lower porto-caval pressure gradient (PCPG) (9 (3-21) mmHg, P = 0.006), a lower rate of dysfunction (8% versus 54%, P = 0.03) and required fewer reinterventions (2 versus 13, P = 0.02); similar results were obtained after 12 months. This resulted in a reduction in the median cost for angiographic surveillance in the covered TIPSS group at 6 and 12 months (36% and 56% compared to the uncovered TIPSS group, P = 0.002), but total procedure-related costs were higher with the ePTFE-TIPSS (6 months: 3730 (3245-6759) versus 1850 (1466-5479) euro/patient; 12 months: 3945 (3460-6759) versus 2295 (1728-5694) euro/patient) due to the higher initial cost of the ePTFE-covered TIPSS.
The insertion of ePTFE-covered TIPSS results in better maintenance of lowered portal pressure and fewer reinterventions in patients with liver cirrhosis. There is strong evidence that the use of ePTFE-TIPSS does not require regular surveillance to maintain primary patency, which may then improve cost-effectiveness.
本研究旨在评估肝硬化患者中，膨体聚四氟乙烯（ePTFE）覆膜经颈静脉肝内门体分流术的通畅性、功能及血流动力学结果。
对13例植入ePTFE覆膜经颈静脉肝内门体分流术支架（TIPSS）的患者进行了6个月和12个月的前瞻性评估，并与匹配的未覆膜金属丝TIPSS对照组进行比较。
6个月时，ePTFE-TIPSS的门静脉-腔静脉压力梯度（PCPG）显著更低（9（3-21）mmHg，P = 0.006），功能障碍发生率更低（8%对54%，P = 0.03），再次干预需求更少（2次对13次，P = 0.02）；12个月后得到了相似结果。这使得覆膜TIPSS组6个月和12个月时血管造影监测的中位成本降低（与未覆膜TIPSS组相比分别降低36%和56%，P = 0.002），但ePTFE-TIPSS的总手术相关成本更高（6个月：3730（3245-6759）欧元/患者对1850（1466-5479）欧元/患者；12个月：3945（3460-6759）欧元/患者对2295（1728-5694）欧元/患者），因为ePTFE覆膜TIPSS的初始成本更高。
植入ePTFE覆膜TIPSS能更好地维持肝硬化患者降低的门静脉压力，减少再次干预。有强有力的证据表明，使用ePTFE-TIPSS不需要定期监测来维持初期通畅性，这可能会提高成本效益。
