联合 Y 型支架治疗闭塞性经颈静脉肝内门体分流术。
Combined Y-configured stents for revising occluded transjugular intrahepatic portosystemic shunt.
机构信息
Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu, China.
Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Chongqing Medical Univeristy, Chongqing, China.
出版信息
Diagn Interv Radiol. 2021 Mar;27(2):238-243. doi: 10.5152/dir.2021.20036.
PURPOSE
We aimed to determine the technical feasibility, safety and prognosis of the transjugular intrahepatic portosystemic shunt (TIPS) revision by combined Y-configured stents placement.
METHODS
We retrospectively evaluated 12 patients who received TIPS revision using Y-stenting technique between June 2015 and January 2019. The rates of technical success, complication, shunt patency, hepatic encephalopathy and mortality were described and analyzed.
RESULTS
The combined Y-configured stents were successfully placed in 11 of 12 patients (92%) without major complications. The median portosystemic pressure gradient (PPG) decreased from 23 mmHg (interquartile range, IQR, 18.5-27.5 mmHg) to 10 mmHg (IQR, 9-14 mmHg). The left internal jugular vein approach was used in 5 patients. Four patients required a shunt extension with an extra stent to resolve the stenosis at the portal venous terminus. Two patients developed hepatic encephalopathy, which was medically controlled within 3 months after the procedure. The TIPS patency and survival rates were both 100% during a median follow-up period of 10 months (IQR, 5.5-14 months).
CONCLUSION
TIPS revision by combined Y-configured stents placement was technically feasible and safe with favorable clinical outcomes.
目的
我们旨在确定通过联合 Y 型支架置入术进行经颈静脉肝内门体分流术（TIPS）翻修的技术可行性、安全性和预后。
方法
我们回顾性评估了 2015 年 6 月至 2019 年 1 月期间接受 Y 型支架技术 TIPS 翻修的 12 例患者。描述和分析了技术成功率、并发症、分流道通畅性、肝性脑病和死亡率。
结果
12 例患者中的 11 例（92%）成功地放置了联合 Y 型支架，没有出现重大并发症。门静脉系统压力梯度（PPG）中位数从 23mmHg（四分位距[IQR]，18.5-27.5mmHg）降至 10mmHg（IQR，9-14mmHg）。5 例患者采用左颈内静脉入路。4 例患者需要额外的支架来扩展分流道以解决门静脉末端的狭窄。2 例患者发生肝性脑病，术后 3 个月内经药物控制。中位随访 10 个月（IQR，5.5-14 个月）期间，TIPS 通畅率和生存率均为 100%。
结论
通过联合 Y 型支架置入术进行 TIPS 翻修具有技术可行性和安全性，临床结果良好。
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