Luo Shi-Hua, Chu Jian-Guo, Huang He, Yao Ke-Chun
Shi-Hua Luo, Jian-Guo Chu, He Huang, Department of Radiology, Air Force General Hospital of PLA, Beijing 100142, China.
World J Gastroenterol. 2017 Jul 14;23(26):4779-4787. doi: 10.3748/wjg.v23.i26.4779.
To evaluate the effect of initial stent position on transjugular intrahepatic portosystemic shunt (TIPS).
We studied 425 patients from January 2004 to January 2015 with refractory ascites or variceal bleeding who required TIPS placement. Patients were randomly divided into group A (stent in hepatic vein, = 57), group B (stent extended to junction of hepatic vein and inferior vena cava, = 136), group C (stent in left branch of portal vein, = 83) and group D (stent in main portal vein, = 149). Primary unassisted patency was compared using Kaplan-Meier analysis, and incidence of recurrence of bleeding, ascites and hepatic encephalopathy (HE) were analyzed.
The mean primary unassisted patency rate in group B tended to be higher than in group A at 3, 6 and 12 mo ( = 0.001, 0.000 and 0.005), and in group D it tended to be lower than in group C at 3, 6 and 12 mo ( = 0.012, 0.000 and 0.028). The median shunt primary patency time for group A was shorter than for group B (5.2 mo 9.1 mo, 95%CI: 4.3-5.6, = 0.013, log-rank test), while for group C it was longer than for group D (8.3 mo 6.9 mo, 95%CI: 6.3-7.6, = 0.025, log-rank test). Recurrence of bleeding and ascites in group A was higher than in group B at 3 mo ( = 0.014 and 0.020), 6 mo ( = 0.014 and 0.019) and 12 mo ( = 0.024 and 0.034. Recurrence in group D was higher than in group C at 3 mo ( = 0.035 and 0.035), 6 mo ( = 0.038 and 0.022) and 12 mo ( = 0.017 and 0.009). The incidence of HE was not significantly different among any of the groups ( = 0.965).
The initial stent position can markedly affect stent patency, which potentially influences the risk of recurrent symptoms associated with shunt stenosis or occlusion.
评估初始支架位置对经颈静脉肝内门体分流术（TIPS）的影响。
我们研究了2004年1月至2015年1月期间425例因顽固性腹水或静脉曲张破裂出血而需要进行TIPS置入术的患者。患者被随机分为A组（支架置于肝静脉，n = 57）、B组（支架延伸至肝静脉与下腔静脉交界处，n = 136）、C组（支架置于门静脉左支，n = 83）和D组（支架置于门静脉主干，n = 149）。采用Kaplan-Meier分析比较原发性无辅助通畅率，并分析出血、腹水和肝性脑病（HE）复发的发生率。
B组在3个月、6个月和12个月时的平均原发性无辅助通畅率倾向于高于A组（P = 0.001、0.000和0.005），D组在3个月、6个月和12个月时的平均原发性无辅助通畅率倾向于低于C组（P = 0.012、0.000和0.028）。A组的分流原发性通畅时间中位数短于B组（5.2个月对9.1个月，95%CI：4.3 - 5.6，P = 0.013，对数秩检验），而C组的分流原发性通畅时间中位数长于D组（8.3个月对6.9个月，95%CI：6.3 - 7.6，P = 0.025，对数秩检验）。A组在3个月（P = 0.014和0.020）、6个月（P = 0.014和0.019）和12个月（P = 0.024和0.034）时的出血和腹水复发率高于B组。D组在3个月（P = 0.035和0.035）、6个月（P = 0.038和0.022）和12个月（P = 0.017和0.009）时的复发率高于C组。各亚组之间HE的发生率无显著差异（P = 0.965）。
初始支架位置可显著影响支架通畅性，这可能会影响与分流狭窄或闭塞相关的复发症状风险。
