Zhou H, Yao X, Tang S H, Xie M, Feng Z S, Qin J P
Department of Gastroenterology, General Hospital of Western Theater Command, Chengdu 610083, China North Sichuan Medical College, Nanchong 637000, China.
Department of Gastroenterology, General Hospital of Western Theater Command, Chengdu 610083, China.
Zhonghua Gan Zang Bing Za Zhi. 2021 Jan 20;29(1):54-59. doi: 10.3760/cma.j.cn501113-20190225-00058.
To investigate the clinical efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) with the use of Viator stent in the treatment of cirrhotic portal hypertension. 43 cases with cirrhotic portal hypertension were implanted with Viatorr stent during TIPS procedure from March 2016 to August 2018. Serological indicators, color Doppler ultrasound, gastroscopy, rebleeding, ascites and hepatic encephalopathy were regularly followed up. Portal venous pressure, liver and kidney function, coagulation indexes were compared by t-test. Stent patency rate, hepatic encephalopathy incidence, rebleeding rate and survival rate were calculated by Kaplan-Meier curve. TIPS procedure success rate was 100% in all patients. Portal pressure gradient was decreased from (25.57 ± 5.50) mmHg to (9.76 ± 2.92) mmHg before and after operation. Alanine aminotransferase (ALT) was significantly higher at 1 month after operation than before operation, but there was no significant difference between 3 and 6 months after and before operation. Total bilirubin, serum ammonia and prothrombin time at 1, 3, and 6 months after operation were higher than before operation. Albumin had no significant change compared with before operation, and creatinine and urea nitrogen were lower than before operation. The cumulative rebleeding rates at 12 and 24 months after operation was 0% and 9%, respectively. Of the 26 patients with ascites, 22 cases (84.6%) had complete disappearance of ascites and 3 (11.5%) had significant decrease of ascites. The cumulative incidence of hepatic encephalopathy at 3, 6, 12 and 24 months after surgery was 11.6%, 17.3%, 21.9% and 21.9%, respectively. The cumulative incidence of stent dysfunction at 12 and 24 months after surgery was 5.6% and 23.7%, respectively. The cumulative survival rate at 12 months and 24 months after surgery was 91.9%. TIPS procedure with Viatorr stent can effectively reduce portal pressure and rebleeding rate, improve intrahepatic shunt patency rate, and will not increase the risk of postoperative hepatic encephalopathy, and has a higher cumulative survival rate.
探讨使用Viator支架经颈静脉肝内门体分流术（TIPS）治疗肝硬化门静脉高压症的临床疗效及安全性。2016年3月至2018年8月期间，43例肝硬化门静脉高压症患者在TIPS手术过程中植入了Viatorr支架。定期随访血清学指标、彩色多普勒超声、胃镜、再出血、腹水及肝性脑病情况。采用t检验比较门静脉压力、肝肾功能、凝血指标。通过Kaplan-Meier曲线计算支架通畅率、肝性脑病发生率、再出血率及生存率。所有患者TIPS手术成功率为100%。术前、后门静脉压力梯度从（25.57±5.50）mmHg降至（9.76±2.92）mmHg。术后1个月丙氨酸氨基转移酶（ALT）显著高于术前，但术后3个月和6个月与术前无显著差异。术后1、3、6个月总胆红素、血清氨及凝血酶原时间均高于术前。白蛋白与术前相比无显著变化，肌酐及尿素氮低于术前。术后12个月和24个月累计再出血率分别为0%和9%。26例腹水患者中，22例（84.6%）腹水完全消失，3例（11.5%）腹水显著减少。术后3、6、12和24个月肝性脑病累计发生率分别为11.6%、17.3%、21.9%和21.9%。术后12个月和24个月支架功能障碍累计发生率分别为5.6%和23.7%。术后12个月和24个月累计生存率为91.9%。使用Viatorr支架的TIPS手术可有效降低门静脉压力及再出血率，提高肝内分流通畅率，且不会增加术后肝性脑病风险，具有较高的累计生存率。
